Healthcare Provider Details

I. General information

NPI: 1629453394
Provider Name (Legal Business Name): JENNIFER COPTHORNE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 08/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8655 S EASTERN AVE
LAS VEGAS NV
89123-2839
US

IV. Provider business mailing address

PO BOX 15645
LAS VEGAS NV
89114-5645
US

V. Phone/Fax

Practice location:
  • Phone: 702-560-2847
  • Fax:
Mailing address:
  • Phone: 702-579-3272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN001981
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN62655
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: