Provider Demographics
NPI:1043023773
Name:COOPER-GILL, DESIREE (RN)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:COOPER-GILL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 CARLSBAD CT
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5877
Mailing Address - Country:US
Mailing Address - Phone:609-377-0129
Mailing Address - Fax:
Practice Address - Street 1:RECOVERY CENTERS OF AMERICA AT LIGHTHOUSE
Practice Address - Street 2:5034 ATLANTIC AVENUE
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330
Practice Address - Country:US
Practice Address - Phone:609-782-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR22830800163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)