Provider Demographics
NPI:1598551475
Name:COOPER, CONSWELLA
Entity type:Individual
Prefix:
First Name:CONSWELLA
Middle Name:
Last Name:COOPER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 N 126TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-1982
Mailing Address - Country:US
Mailing Address - Phone:531-283-2340
Mailing Address - Fax:
Practice Address - Street 1:5010 N 126TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-1982
Practice Address - Country:US
Practice Address - Phone:531-283-2340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant