1154624617 NPI number — LANA J COOPER P.A.

Table of content: LANA J COOPER P.A. (NPI 1154624617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154624617 NPI number — LANA J COOPER P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COOPER
Provider First Name:
LANA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALLEN
Provider Other First Name:
LANA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.A.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154624617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 INDUSTRIAL DR STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISBURG
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27549-2371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-496-2533
Provider Business Mailing Address Fax Number:
919-496-8140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 INDUSTRIAL DR STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISBURG
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27549-2371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-496-2533
Provider Business Practice Location Address Fax Number:
919-496-8140
Provider Enumeration Date:
12/06/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  0010-02602 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)