Healthcare Provider Details

I. General information

NPI: 1306734421
Provider Name (Legal Business Name): MACKENZIE NICOLE COPELAND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PENFIELD AVE
AKRON OH
44310-2912
US

IV. Provider business mailing address

825 MATTHIAS AVE NE
MASSILLON OH
44646-4493
US

V. Phone/Fax

Practice location:
  • Phone: 330-762-6110
  • Fax:
Mailing address:
  • Phone: 330-704-2041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number540496
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: