Provider Demographics
NPI:1659554368
Name:COOPER, DEBORA ANNE (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:DEBORA
Middle Name:ANNE
Last Name:COOPER
Suffix:
Gender:F
Credentials:RD, LDN
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Mailing Address - Street 1:1736 W HAMILTON ST
Mailing Address - Street 2:ST. LUKE'S HOSPITAL NUTRITIONAL SERVICES
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5656
Mailing Address - Country:US
Mailing Address - Phone:610-770-8386
Mailing Address - Fax:610-770-8432
Practice Address - Street 1:1736 W HAMILTON ST
Practice Address - Street 2:ST. LUKE'S HOSPITAL NUTRITIONAL SERVICES
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5656
Practice Address - Country:US
Practice Address - Phone:610-770-8386
Practice Address - Fax:610-770-8432
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADN000890133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA072239SNGMedicare PIN