Healthcare Provider Details

I. General information

NPI: 1679397921
Provider Name (Legal Business Name): BRADLEY KOPF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 MULBERRY AVE
MUSCATINE IA
52761-3433
US

IV. Provider business mailing address

1518 MULBERRY AVE
MUSCATINE IA
52761-3433
US

V. Phone/Fax

Practice location:
  • Phone: 563-264-9100
  • Fax:
Mailing address:
  • Phone: 563-264-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA181840
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number162463
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: