Healthcare Provider Details

I. General information

NPI: 1679545719
Provider Name (Legal Business Name): DEBORAH JEAN COPELAND RN, BSN, CGRN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: DEBORAH JEAN WALZ RN, BSN, CGRN

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S DOBSON RD
MESA AZ
85202-4707
US

IV. Provider business mailing address

4615 E PEARCE RD
PHOENIX AZ
85044-1126
US

V. Phone/Fax

Practice location:
  • Phone: 480-512-3800
  • Fax: 480-512-8756
Mailing address:
  • Phone: 480-598-9945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License NumberRN043736
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: