Provider Demographics
NPI:1093484297
Name:COUPAL, CAMILLE MARIE (RN-BC)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:MARIE
Last Name:COUPAL
Suffix:
Gender:F
Credentials:RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SAGE TRAIL RD TRLR 4
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-9303
Mailing Address - Country:US
Mailing Address - Phone:509-367-3190
Mailing Address - Fax:
Practice Address - Street 1:802 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:TOPPENISH
Practice Address - State:WA
Practice Address - Zip Code:98948-1668
Practice Address - Country:US
Practice Address - Phone:509-865-3955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00080071163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology