Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | 38992 | KY |
N | 207VX0000X | Obstetrician | 38992 | KY |
Y | 207VX0201X | Gynecologic Oncologist | M9920 | ID |
NPI | 1306880398 |
---|---|
Provider Name | Amy L. Cooper |
First Address | Boise, ID 83712-6241 |
Second Address | Boise, ID 83712-6267 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 28/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64082670 | (05) | KY |