Provider Demographics
NPI:1114511599
Name:COOPER, DAKOTA LANA (DTR)
Entity Type:Individual
Prefix:
First Name:DAKOTA
Middle Name:LANA
Last Name:COOPER
Suffix:
Gender:F
Credentials:DTR
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:VICTORIA
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3315 S DORSEY LN
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5704
Mailing Address - Country:US
Mailing Address - Phone:847-331-0493
Mailing Address - Fax:
Practice Address - Street 1:3315 S DORSEY LN
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5704
Practice Address - Country:US
Practice Address - Phone:847-331-0493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered