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General NPI Number Information
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NPI Number | 1609146786
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Entity Type | Individual
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Provider Name | ROBERT D COPIC R.N.
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Gender | Male
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Dates
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Enumeration Date | 01/06/2012
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Last Update Date | 01/06/2012
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Provider Practice Location Address
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Address Line | 521 BROADWAY AVE N
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City | BRAHAM
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State | MN
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Zip | 55006-4711
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Country | US
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Telephone | 320-396-3333
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Fax | 320-396-3363
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Provider Business Mailing Address
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Address Line | 11335 246TH CIR
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City | ZIMMERMAN
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State | MN
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Zip | 55398-4663
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Country | US
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Telephone | 763-856-0121
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Fax | 320-396-3363
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 169978-2
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License Number State | MN
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