Healthcare Provider Details

I. General information

NPI: 1942536636
Provider Name (Legal Business Name): MITZIE A. COPE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 EAST 23RD STREET
BROOKLYN NY
11226-7008
US

IV. Provider business mailing address

343 EAST 23RD STREET
BROOKLYN NY
11226-7008
US

V. Phone/Fax

Practice location:
  • Phone: 347-564-3344
  • Fax:
Mailing address:
  • Phone: 347-564-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number622320-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number622320-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: