Provider Demographics
NPI:1942865365
Name:COOPER, MARTA (FNP-BC, APNP)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:FNP-BC, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E8890 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN DELLS
Mailing Address - State:WI
Mailing Address - Zip Code:53965-9808
Mailing Address - Country:US
Mailing Address - Phone:608-432-2250
Mailing Address - Fax:
Practice Address - Street 1:579 DONOFRIO DR STE 1
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2838
Practice Address - Country:US
Practice Address - Phone:608-820-2381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI921833363LF0000X
WI9218-33207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily