Basic Information
| Provider Information | |||||||||
| NPI: | 1942256730 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOOPER | ||||||||
| FirstName: | ELAINE | ||||||||
| MiddleName: | MARIAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 385 RANCH ROAD | ||||||||
| Address2: | |||||||||
| City: | REEDSPORT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974670843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204150330 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 385 RANCH ROAD | ||||||||
| Address2: | |||||||||
| City: | REEDSPORT | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412712119 | ||||||||
| FaxNumber: | 5412719338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 06/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | RN050550 | AZ | N | Nursing Service Providers | Registered Nurse | General Practice | 363LA2200X | AP6266 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LG0600X | AP6266 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.