Healthcare Provider Details

I. General information

NPI: 1992250690
Provider Name (Legal Business Name): JENETTE COPE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 UNIVERSITY AVE SUITE 120
SACRAMENTO CA
95825-6531
US

IV. Provider business mailing address

333 UNIVERSITY AVE SUITE 120
SACRAMENTO CA
95825-6531
US

V. Phone/Fax

Practice location:
  • Phone: 916-929-8564
  • Fax: 916-929-4529
Mailing address:
  • Phone: 916-929-8564
  • Fax: 916-929-4529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004659
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95004659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: