Healthcare Provider Details

I. General information

NPI: 1730388919
Provider Name (Legal Business Name): ANNA COLEEN COPELAND ROBERT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 YORK RD
TOWSON MD
21204-2516
US

IV. Provider business mailing address

920 2ND AVE S SUITE #400
MINNEAPOLIS MN
55402-3318
US

V. Phone/Fax

Practice location:
  • Phone: 410-823-3900
  • Fax:
Mailing address:
  • Phone: 612-659-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR175190
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: