Provider Demographics
NPI:1154674083
Name:COPPAGE, VERONICA RIVERA (RD)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:RIVERA
Last Name:COPPAGE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N HERMAN STREET BOX CC
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-2973
Mailing Address - Country:US
Mailing Address - Phone:919-731-1276
Mailing Address - Fax:919-705-6526
Practice Address - Street 1:301 N HERMAN STREET BOX CC
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-2973
Practice Address - Country:US
Practice Address - Phone:919-731-1276
Practice Address - Fax:919-705-6526
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004073133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered