MEDICARE: MARY E COPLIN FNP

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
1	363LC1500X	Community Health Nurse Practitioner	P99471	OH
2	363LF0000X	Family Nurse Practitioner	COA.07555	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285804856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY E COPLIN FNP

Provider Business Mailing Address
First Line	:	PO BOX 636372
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-0001
Country	:	US
Telephone Number	:	419-226-9120
Fax Number	:	419-996-5410

Provider Business Practice Location Address
First Line	:	1800 E 5TH ST
Second Line	:
City	:	DELPHOS
State	:	OH
Zip	:	45833-9180
Country	:	US
Telephone Number	:	419-996-5030
Fax Number	:	419-996-5458

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2008
Last Update Date	:	06/30/2017

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