Healthcare Provider Details

I. General information

NPI: 1346432770
Provider Name (Legal Business Name): ANNA C KOOPMAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OLD YORK RD
ABINGTON PA
19001-3720
US

IV. Provider business mailing address

1101 MARKET ST FL 30
PHILADELPHIA PA
19107-2934
US

V. Phone/Fax

Practice location:
  • Phone: 215-481-6784
  • Fax:
Mailing address:
  • Phone:
  • Fax: 856-922-9890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-113403
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP022800
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: