MEDICARE: AMY MARIE COAPMAN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NP5908	CA

General Provider Information

NPI Number	:	1700804614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MARIE COAPMAN FNP

Provider Business Mailing Address
First Line	:	1519 S OREGON ST
Second Line	:
City	:	YREKA
State	:	CA
Zip	:	96097-3425
Country	:	US
Telephone Number	:	530-842-9200
Fax Number	:	530-842-9207

Provider Business Practice Location Address
First Line	:	1519 S OREGON ST
Second Line	:
City	:	YREKA
State	:	CA
Zip	:	96097-3425
Country	:	US
Telephone Number	:	530-842-9200
Fax Number	:	530-842-9207

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	07/08/2007

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