Healthcare Provider Details

I. General information

NPI: 1316054059
Provider Name (Legal Business Name): SUZANNE KOPROWSKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 SE 13TH ST
GRAND RAPIDS MN
55744-4257
US

IV. Provider business mailing address

3920 13TH AVE E SUITE 6
HIBBING MN
55746-3675
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-9100
  • Fax: 218-326-9200
Mailing address:
  • Phone: 219-263-7540
  • Fax: 866-732-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR0612401
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: