Provider Demographics
NPI:1710208400
Name:COPELAND, STEPHANIE L
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:L
Last Name:COPELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74103-3410
Mailing Address - Country:US
Mailing Address - Phone:918-585-3045
Mailing Address - Fax:918-585-3047
Practice Address - Street 1:115 W 3RD ST
Practice Address - Street 2:SUITE 800
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74103-3410
Practice Address - Country:US
Practice Address - Phone:918-585-3045
Practice Address - Fax:918-585-3047
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK957133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty