Healthcare Provider Details

I. General information

NPI: 1336122555
Provider Name (Legal Business Name): RAYNA GAIL COOPER RD,LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: RAYNA GAIL PICKARD

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3461 MARKET ST SUITE 200
CAMP HILL PA
17011-4412
US

IV. Provider business mailing address

210 W BROADWAY
GETTYSBURG PA
17325-1203
US

V. Phone/Fax

Practice location:
  • Phone: 717-761-7380
  • Fax: 717-763-4779
Mailing address:
  • Phone: 717-761-7380
  • Fax: 717-763-4779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDN000569
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: