Healthcare Provider Details

I. General information

NPI: 1538181839
Provider Name (Legal Business Name): DENISE ELIZABETH KOOPERMAN N.P., M.S.N., C.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 N TIOGA ST
ITHACA NY
14850-4205
US

IV. Provider business mailing address

99 CAYUGA ST
TRUMANSBURG NY
14886-9182
US

V. Phone/Fax

Practice location:
  • Phone: 607-272-1014
  • Fax: 607-272-3547
Mailing address:
  • Phone: 607-387-3128
  • Fax: 607-272-3547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberF400114-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: