Provider Demographics
NPI:1013022235
Name:COPPERNOLL, LANA MAY (EFDA, CDA)
Entity Type:Individual
Prefix:MRS
First Name:LANA
Middle Name:MAY
Last Name:COPPERNOLL
Suffix:
Gender:F
Credentials:EFDA, CDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2053 NW FARGO CT
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7953
Mailing Address - Country:US
Mailing Address - Phone:380-833-4505
Mailing Address - Fax:
Practice Address - Street 1:2053 NW FARGO CT
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607
Practice Address - Country:US
Practice Address - Phone:380-833-4505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA868OtherKAISER PERMENTE DENTAL