Provider Demographics
NPI:1336837384
Name:COPPOLA, NATALIE LOUISE (RD)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:LOUISE
Last Name:COPPOLA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 WILSON BLVD APT 4
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-3847
Mailing Address - Country:US
Mailing Address - Phone:315-370-0070
Mailing Address - Fax:
Practice Address - Street 1:2523 WILSON BLVD APT 4
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-3847
Practice Address - Country:US
Practice Address - Phone:315-370-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI200001377133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered