Healthcare Provider Details

I. General information

NPI: 1952406704
Provider Name (Legal Business Name): KIM MARIE NOWAK-COOPERMAN R.D.,C.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIM COOPERMAN R.D.,C.D.

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDREN'S HOSPITAL AND REGIONAL MEDICAL CENTER 4800 SAND POINT WAY NE M/S 3726
SEATTLE WA
98105-0371
US

IV. Provider business mailing address

7044 JONES AVE NW
SEATTLE WA
98117-5655
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2087
  • Fax: 206-987-5087
Mailing address:
  • Phone: 206-781-0648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: