Healthcare Provider Details

I. General information

NPI: 1245414663
Provider Name (Legal Business Name): HEATHER ANN COPEMAN RN,BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 12/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 KNOLLCROFT RD
LYONS NJ
07939-5001
US

IV. Provider business mailing address

554 TOBIAS DR
HELLERTOWN PA
18055-1818
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-0180
  • Fax:
Mailing address:
  • Phone: 908-647-0180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN313264L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: