Healthcare Provider Details

I. General information

NPI: 1437598497
Provider Name (Legal Business Name): JENNIFER ANNE KOPECKI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2013
Last Update Date: 06/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E HIGH ST
POTTSTOWN PA
19464-5008
US

IV. Provider business mailing address

818 CRESTVIEW RD
PHILADELPHIA PA
19128-2303
US

V. Phone/Fax

Practice location:
  • Phone: 610-327-7000
  • Fax:
Mailing address:
  • Phone: 215-470-8839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN568959
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: