Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A116674 | CA |
Y | 208600000X | Surgeon | A116674 | CA |
N | 208200000X | Surgeon | ML20008204 | WA |
N | 208600000X | Surgeon | ML20008204 | WA |
NPI | 1003920596 |
---|---|
Provider Name | Ellen Michele Cooper |
First Address | Truckee, CA 96161-4870 |
Second Address | Truckee, CA 96161-4870 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 16/02/2012 |