Individual
EILZABETH CONVERY COPPOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS, MS
Contact information
Practice address
600 BROADWAY ST, LONGVIEW, WA 98632-3256
(360) 636-4943
(360) 414-7674
Mailing address
PO BOX 249, LONGVIEW, WA 98632-7154
(360) 414-2048
(360) 575-6749
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DI00001498
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100431
—
OR
05
—
8331332
—
WA
Enumeration date
09/09/2005
Last updated
09/24/2009
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