Healthcare Provider Details

I. General information

NPI: 1053637298
Provider Name (Legal Business Name): CORINNE ANN COPPINGER RNC, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2010
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 E 5TH ST SUITE 200
WASHINGTON MO
63090-3135
US

IV. Provider business mailing address

851 E 5TH ST SUITE 200
WASHINGTON MO
63090-3135
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-8585
  • Fax:
Mailing address:
  • Phone: 636-239-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2010011497
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: