Provider Demographics
NPI:1235444712
Name:COOPER, CHRISTINE CARINO (MS,RD,LDN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:CARINO
Last Name:COOPER
Suffix:
Gender:F
Credentials:MS,RD,LDN
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:CHARISE
Other - Last Name:CARINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3103 MANHASSET LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3499
Mailing Address - Country:US
Mailing Address - Phone:570-575-3220
Mailing Address - Fax:
Practice Address - Street 1:3103 MANHASSET LN
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3499
Practice Address - Country:US
Practice Address - Phone:570-575-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered