Healthcare Provider Details

I. General information

NPI: 1588091730
Provider Name (Legal Business Name): AMY MARIE COPPEANS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 01/27/2023
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 BREN ROAD EAST, MAIL ROUTE MN 008-B213
MINNETONKA MN
55343
US

IV. Provider business mailing address

9900 BREN ROAD EAST, MAIL ROUTE MN 008-B213
MINNETONKA MN
55343
US

V. Phone/Fax

Practice location:
  • Phone: 866-799-5886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60400786
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: