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Individual

AUDREY COOPER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RD, LD

Contact information

Practice address
35 MILES ST, DAMARISCOTTA, ME 04543-4047
(207) 563-4559
Mailing address
35 MILES ST, DAMARISCOTTA, ME 04543-4047

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DI1736
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
DI1736
STATE LICENSE NUMBER
ME
Enumeration date
08/29/2022
Last updated
08/29/2022
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