Healthcare Provider Details

I. General information

NPI: 1477958775
Provider Name (Legal Business Name): MRS. DENIZ F. KOPRULU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14701 DETROIT AVE SUITE 620
LAKEWOOD OH
44107-4115
US

IV. Provider business mailing address

14701 DETROIT AVENUE SUITE 620
LAKEWOOD OH
44107
US

V. Phone/Fax

Practice location:
  • Phone: 216-226-5000
  • Fax:
Mailing address:
  • Phone: 216-226-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA 16404-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: