Healthcare Provider Details

I. General information

NPI: 1326978529
Provider Name (Legal Business Name): DEDDEH COPPOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PLAZA DR STE 210
ROSTRAVER TOWNSHIP PA
15012-4019
US

IV. Provider business mailing address

203 ALFRED PL
GREENSBURG PA
15601-9388
US

V. Phone/Fax

Practice location:
  • Phone: 724-379-6850
  • Fax:
Mailing address:
  • Phone: 703-943-8802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP034075
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: