Healthcare Provider Details

I. General information

NPI: 1437550712
Provider Name (Legal Business Name): JESSICA KOOPMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N SAINT JOSEPH AVE
MARSHFIELD WI
54449-1832
US

IV. Provider business mailing address

611 N SAINT JOSEPH AVE
MARSHFIELD WI
54449-1832
US

V. Phone/Fax

Practice location:
  • Phone: 715-221-6188
  • Fax:
Mailing address:
  • Phone: 715-221-6188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number19015-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: