Provider Demographics
NPI:1023341898
Name:COOPER, CHERIE L (NP)
Entity type:Individual
Prefix:
First Name:CHERIE
Middle Name:L
Last Name:COOPER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8120 TIMBERLAKE WAY
Mailing Address - Street 2:STE 101
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5412
Mailing Address - Country:US
Mailing Address - Phone:916-423-2124
Mailing Address - Fax:916-423-2127
Practice Address - Street 1:8120 TIMBERLAKE WAY
Practice Address - Street 2:STE 101
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5412
Practice Address - Country:US
Practice Address - Phone:916-423-2124
Practice Address - Fax:916-423-2127
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14964363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03024ZMedicaid
CAZZZ80876ZMedicaid
CA14964OtherRN
CACT709ZOtherMEDICARE PROVIDER NUMBER--PTAN
CAQ54770Medicare UPIN
CA14964OtherRN