Most Relevant Information
Provider Data
| NPI Number: | 1003669359 |
| Provider Name: | DESTINE COOPER |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | 350093 |
Most Important Dates
| Enumeration Date: | 04/08/2024 |
| Last Updated: | 04/08/2024 |
Provider Practice Location
240 ONEIDA ST
ROCHESTER
NY
146214032
Practice Location Phone/Fax
| Phone: | 5854151429 |
| Fax: |
Provider Mailing Location
240 ONEIDA ST
ROCHESTER
NY
146214032
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |