Provider Demographics
NPI:1184877375
Name:COOPER-MESHBESHER, NANCY (RD)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:COOPER-MESHBESHER
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 1:3800 PARK NICOLLET BLVD
Mailing Address - Street 2:INTERNATIONAL DIABETES CENTER
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2527
Mailing Address - Country:US
Mailing Address - Phone:952-993-3542
Mailing Address - Fax:952-993-0849
Practice Address - Street 1:3800 PARK NICOLLET BLVD
Practice Address - Street 2:INTERNATIONAL DIABETES CENTER
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2527
Practice Address - Country:US
Practice Address - Phone:952-993-3542
Practice Address - Fax:952-993-0849
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN1238133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN710000199Medicare UPIN