Healthcare Provider Details

I. General information

NPI: 1861327439
Provider Name (Legal Business Name): KATHERINE GRACE KOPRIVA WILES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 N QUINN ST APT 220
ARLINGTON VA
22209-1336
US

IV. Provider business mailing address

1808 N QUINN ST APT 220
ARLINGTON VA
22209-1336
US

V. Phone/Fax

Practice location:
  • Phone: 414-581-7815
  • Fax:
Mailing address:
  • Phone: 414-581-7815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN500023917
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2020020269
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: