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NPI Code Detail

MEDICARE: REBECCA COPPAGE

MEDICARE: REBECCA COPPAGE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0222XCritical Care Pediatric Nurse Practitioner2013014535MO

General Provider Information

NPI Number : 1053758979
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA COPPAGE
Provider Business Mailing Address
First Line : 2401 GILLHAM RD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64108-4619
Country : US
Telephone Number : 816-234-3000
Fax Number :
Provider Business Practice Location Address
First Line : 2401 GILLHAM RD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64108-4619
Country : US
Telephone Number : 816-234-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2013
Last Update Date : 06/01/2013

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Directions to “ REBECCA COPPAGE ” Practice Location

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