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General NPI Number Information
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NPI Number | 1992036339
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Entity Type | Individual
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Provider Name | LINDSEY DIANE KOPPERUD NP,PHN, BSN, ANP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/25/2010
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 2315 STOCKTON BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95817-2201
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Country | US
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Telephone | 916-734-2011
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Fax |
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Provider Business Mailing Address
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Address Line | 4805 POLO CT
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City | FAIR OAKS
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State | CA
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Zip | 95628-5266
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Country | US
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Telephone | 530-521-7740
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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 | 10898
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 653636
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License Number State | CA
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