Healthcare Provider Details

I. General information

NPI: 1922855519
Provider Name (Legal Business Name): COPPER STATE HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42068 N RATTLESNAKE RD
SAN TAN VALLEY AZ
85140-8858
US

IV. Provider business mailing address

42068 N RATTLESNAKE RD
SAN TAN VALLEY AZ
85140-8858
US

V. Phone/Fax

Practice location:
  • Phone: 480-326-4997
  • Fax: 602-848-8890
Mailing address:
  • Phone: 480-326-4997
  • Fax: 602-848-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIE EKREN
Title or Position: OWNER
Credential: FNP-C
Phone: 480-326-4997