Healthcare Provider Details

I. General information

NPI: 1548324957
Provider Name (Legal Business Name): MRS. BARBARA JEAN COPPLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 CENTER ST NE
SALEM OR
97301-4532
US

IV. Provider business mailing address

7069 COMBEST LN SE
TURNER OR
97392-9710
US

V. Phone/Fax

Practice location:
  • Phone: 503-588-5621
  • Fax: 503-566-2920
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: