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General NPI Number Information
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NPI Number | 1992219570
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Entity Type | Individual
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Provider Name | NATHAN ANDREW KOPPE CNP
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Gender | Male
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Dates
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Enumeration Date | 11/19/2017
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 6936 PINE ARBOR DR S
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-4645
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Country | US
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Telephone | 651-326-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 UNIVERSITY AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55104-3727
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Country | US
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 5651
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License Number State | MN
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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 | 5651
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 5651
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License Number State | MN
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