Healthcare Provider Details

I. General information

NPI: 1538191978
Provider Name (Legal Business Name): CHRISTINA F KOPEIKA C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 ELM PL SUITE 203
HIGHLAND PARK IL
60035-2538
US

IV. Provider business mailing address

480 ELM PL SUITE 203
HIGHLAND PARK IL
60035-2538
US

V. Phone/Fax

Practice location:
  • Phone: 847-433-0404
  • Fax: 847-433-1389
Mailing address:
  • Phone: 847-433-0404
  • Fax: 847-433-1389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209-005654
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: