Healthcare Provider Details

I. General information

NPI: 1518461169
Provider Name (Legal Business Name): DANIELLE ANNE KOPPERT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD
DETROIT MI
48202-2608
US

IV. Provider business mailing address

337 ARLINGTON BLVD
WINDSOR ONTARIO
828
CA

V. Phone/Fax

Practice location:
  • Phone: 519-551-5926
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704291571
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704291571
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: