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General NPI Number Information
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NPI Number | 1538181839
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Entity Type | Individual
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Provider Name | DENISE ELIZABETH KOOPERMAN N.P., M.S.N., C.S.
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Gender | Female
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 313 N TIOGA ST
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City | ITHACA
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State | NY
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Zip | 14850-4205
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Country | US
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Telephone | 607-272-1014
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Fax | 607-272-3547
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Provider Business Mailing Address
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Address Line | 99 CAYUGA ST
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City | TRUMANSBURG
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State | NY
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Zip | 14886-9182
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Country | US
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Telephone | 607-387-3128
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Fax | 607-272-3547
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | F400114-1
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License Number State | NY
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