Healthcare Provider Details

I. General information

NPI: 1619880101
Provider Name (Legal Business Name): AMY KOPPIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY MERKWAN

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7628 W SPUR DR
PEORIA AZ
85383-6212
US

IV. Provider business mailing address

7628 W SPUR DR
PEORIA AZ
85383-6212
US

V. Phone/Fax

Practice location:
  • Phone: 605-929-3546
  • Fax:
Mailing address:
  • Phone: 605-929-3546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number235314
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: