Healthcare Provider Details

I. General information

NPI: 1932368339
Provider Name (Legal Business Name): MARIANNE HELEN COPPENS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 HAWKSBRIDGE CIRCLE
TEMPERANCE MI
48182-9223
US

IV. Provider business mailing address

733 HAWKSBRIDGE CIR
TEMPERANCE MI
48182-9137
US

V. Phone/Fax

Practice location:
  • Phone: 419-356-1688
  • Fax:
Mailing address:
  • Phone: 419-356-1688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number4704256304
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704256304
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: