Provider Demographics
NPI:1952406704
Name:NOWAK-COOPERMAN, KIM MARIE (RD,CD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:NOWAK-COOPERMAN
Suffix:
Gender:F
Credentials:RD,CD
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:COOPERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD,CD
Mailing Address - Street 1:7044 JONES AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5655
Mailing Address - Country:US
Mailing Address - Phone:206-781-0648
Mailing Address - Fax:
Practice Address - Street 1:CHILDREN'S HOSPITAL AND REGIONAL MEDICAL CENTER
Practice Address - Street 2:4800 SAND POINT WAY NE M/S 3726
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-0371
Practice Address - Country:US
Practice Address - Phone:206-987-2087
Practice Address - Fax:206-987-5087
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8261786Medicaid
WADI00000095OtherCERTIFIED DIETITIAN