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General NPI Number Information
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NPI Number | 1518461169
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Entity Type | Individual
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Provider Name | DANIELLE ANNE KOPPERT NP
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Gender | Female
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 2799 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202-2608
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Country | US
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Telephone | 519-551-5926
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Fax |
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Provider Business Mailing Address
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Address Line | 337 ARLINGTON BLVD
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City | WINDSOR
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State | ONTARIO
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Zip | 828
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Country | CA
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704291571
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 4704291571
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License Number State | MI
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