Healthcare Provider Details

I. General information

NPI: 1619288222
Provider Name (Legal Business Name): ERIN N KOPIETZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN N JOHNSON APRN

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S 23RD ST INSIDE PAMIDA
PLATTSMOUTH NE
68048-2903
US

IV. Provider business mailing address

3901 PINE LAKE RD SUITE 211
LINCOLN NE
68516-5497
US

V. Phone/Fax

Practice location:
  • Phone: 402-296-5100
  • Fax: 402-296-5107
Mailing address:
  • Phone: 402-423-4200
  • Fax: 402-423-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number111165
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: