Provider Demographics
NPI:1750430807
Name:COOPER, LINDA R (NMW)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:R
Last Name:COOPER
Suffix:
Gender:F
Credentials:NMW
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Other - First Name:
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Mailing Address - Street 1:4168 FRONT ST
Mailing Address - Street 2:MC 8434
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2030
Mailing Address - Country:US
Mailing Address - Phone:619-543-6790
Mailing Address - Fax:619-543-5350
Practice Address - Street 1:4168 FRONT ST
Practice Address - Street 2:MC 8434
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2030
Practice Address - Country:US
Practice Address - Phone:619-543-6790
Practice Address - Fax:619-543-5350
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CANMW1527367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife