Healthcare Provider Details

I. General information

NPI: 1134366982
Provider Name (Legal Business Name): JUNE KAY KOPIASZ BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BOATS LN
SPRING LAKE NC
28390-7302
US

IV. Provider business mailing address

840 QUINCE RD
HARLAN IA
51537-5610
US

V. Phone/Fax

Practice location:
  • Phone: 910-568-0040
  • Fax:
Mailing address:
  • Phone: 712-579-7004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number145221
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberP42342
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: