Healthcare Provider Details

I. General information

NPI: 1083985220
Provider Name (Legal Business Name): COURTNEY NICOLE COPELAND CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRANT ST FL 58
PITTSBURGH PA
15219-2739
US

IV. Provider business mailing address

1350 SPEER BLVD APT 610
DENVER CO
80204-2669
US

V. Phone/Fax

Practice location:
  • Phone: 412-367-6700
  • Fax:
Mailing address:
  • Phone: 740-361-1423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN756627
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704287297
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN756627
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: