Basic Information
Provider Information
NPI: 1417403874
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COOPER
FirstName: BRITTANY
MiddleName: DEMAY
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3333 BURNET AVE # MLC5021
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452293026
CountryCode: US
TelephoneNumber: 5136364225
FaxNumber: 5136362511
Practice Location
Address1: 3333 BURNET AVE
Address2: MLC 7015
City: CINCINNATI
State: OH
PostalCode: 452293026
CountryCode: US
TelephoneNumber: 5136364266
FaxNumber: 5136363549
Other Information
ProviderEnumerationDate: 08/26/2016
LastUpdateDate: 09/25/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/25/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200XAPRN.CNP.019743OHN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
363L00000XAPRN.CNP.019743OHY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


Home