Provider Demographics
NPI:1780322834
Name:COOPER, GRACE (RD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:COOPER
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 1:4900 COX RD STE 155
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6507
Mailing Address - Country:US
Mailing Address - Phone:804-726-8571
Mailing Address - Fax:804-726-8574
Practice Address - Street 1:3000 WATERCOVE RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3982
Practice Address - Country:US
Practice Address - Phone:804-744-0200
Practice Address - Fax:804-744-8417
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered