Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 036123626 | IL |
N | 207VX0000X | Obstetrician | MD156781 | OR |
Y | 207VX0000X | Obstetrician | MD60299784 | WA |
NPI | 1275706608 |
---|---|
Provider Name | Dr. Jacqueline Lynn Young Cooper |
First Address | Vancouver, WA 98686 |
Second Address | Vancouver, WA 98686 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2008 |
Last Update Date | 02/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036123626 | (05) | IL |