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General NPI Number Information
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NPI Number | 1053746867
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Entity Type | Individual
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Provider Name | ROBERT KOPEC DNP, ARNP
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Gender | Male
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 01/08/2018
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Provider Practice Location Address
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Address Line | 5702 N 26TH ST STE 1A
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City | TACOMA
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State | WA
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Zip | 98407-2406
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Country | US
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Telephone | 253-503-6761
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Fax |
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Provider Business Mailing Address
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Address Line | 4009 BRIDGEPORT WAY W SUITE 1A
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-4326
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Country | US
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Telephone | 253-503-6761
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP60411730
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License Number State | WA
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