Healthcare Provider Details

I. General information

NPI: 1982254454
Provider Name (Legal Business Name): MS. MAXIME V COPLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FLUGPLATZ BLDG 2121
RAMSTEIN-MIESENBACH RAMSTEIN
66877
DE

IV. Provider business mailing address

PSC 2 BOX 15619
APO AE
09012-0157
US

V. Phone/Fax

Practice location:
  • Phone: 63-714-6227
  • Fax:
Mailing address:
  • Phone: 863-253-1440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: