Healthcare Provider Details

I. General information

NPI: 1629598958
Provider Name (Legal Business Name): MOLLY LYNN COPELAND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY LYNN JIM

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 09/12/2025
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46314 TIMINE WAY
PENDLETON OR
97801-9417
US

IV. Provider business mailing address

PO BOX 160
PENDLETON OR
97801-0160
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-9830
  • Fax: 541-240-8754
Mailing address:
  • Phone: 541-966-9830
  • Fax: 541-240-8740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201708063RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: