Healthcare Provider Details

I. General information

NPI: 1932925567
Provider Name (Legal Business Name): SARAH COPPENS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 DUSTIN RD APT 209
OREGON OH
43616-3391
US

IV. Provider business mailing address

7415 CONSEAR RD
OTTAWA LAKE MI
49267-9720
US

V. Phone/Fax

Practice location:
  • Phone: 419-367-3569
  • Fax:
Mailing address:
  • Phone: 419-367-3569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.405405
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: