Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 245139 | TX |
NPI | 1104841964 |
---|---|
Provider Name | Mrs. Glenda Sue Cooper |
First Address | Fort Hood, TX 76544 |
Second Address | Fort Hood, TX 76544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/07/2007 |