Healthcare Provider Details

I. General information

NPI: 1881392538
Provider Name (Legal Business Name): NEUNG R KOPTER-MEREDITH DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDICE KOPTER

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LAKE TRAVERSE DR
SISSETON SD
57262-7046
US

IV. Provider business mailing address

901 N AMELIA AVE
DELAND FL
32724-2863
US

V. Phone/Fax

Practice location:
  • Phone: 605-698-7606
  • Fax:
Mailing address:
  • Phone: 606-203-5657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11024270
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: