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Individual

MS. DENISE ELIZABETH KOOPERMAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
N.P., M.S.N., C.S.

Contact information

Practice address
313 N TIOGA ST, ITHACA, NY 14850-4205
(607) 272-1014
(607) 272-3547
Mailing address
99 CAYUGA ST, TRUMANSBURG, NY 14886-9182
(607) 387-3128
(607) 272-3547

Taxonomy

Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
F400114-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02509924
NY
Enumeration date
07/24/2006
Last updated
07/08/2007
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