Provider Demographics
NPI:1588465090
Name:COOPER, LYLE CHRISTINE
Entity type:Individual
Prefix:
First Name:LYLE
Middle Name:CHRISTINE
Last Name:COOPER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:LYLE
Other - Middle Name:CHRISTINE
Other - Last Name:BLUMENEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2650 NE 6TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3880
Mailing Address - Country:US
Mailing Address - Phone:720-842-9707
Mailing Address - Fax:
Practice Address - Street 1:28180 SE GERBER CT
Practice Address - Street 2:
Practice Address - City:EAGLE CREEK
Practice Address - State:OR
Practice Address - Zip Code:97022-8724
Practice Address - Country:US
Practice Address - Phone:720-842-9707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10021401163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health