Healthcare Provider Details

I. General information

NPI: 1891136123
Provider Name (Legal Business Name): NATALIE RENEE MOPPERT MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 CULTURAL PARK BLVD
CAPE CORAL FL
33990-1217
US

IV. Provider business mailing address

1105 CULTURAL PARK BLVD
CAPE CORAL FL
33990-1217
US

V. Phone/Fax

Practice location:
  • Phone: 239-931-9720
  • Fax:
Mailing address:
  • Phone: 239-931-9720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: