Provider Demographics
NPI:1336122555
Name:COOPER, RAYNA GAIL (RD,LDN)
Entity Type:Individual
Prefix:
First Name:RAYNA
Middle Name:GAIL
Last Name:COOPER
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:RAYNA
Other - Middle Name:GAIL
Other - Last Name:PICKARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-1203
Mailing Address - Country:US
Mailing Address - Phone:717-761-7380
Mailing Address - Fax:717-763-4779
Practice Address - Street 1:3461 MARKET ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4412
Practice Address - Country:US
Practice Address - Phone:717-761-7380
Practice Address - Fax:717-763-4779
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000569133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist