Provider Demographics
NPI:1164569588
Name:COPPAGE-LAWRENCE, MARTHA (CPNP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:COPPAGE-LAWRENCE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DILLON DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-5167
Mailing Address - Country:US
Mailing Address - Phone:302-832-5400
Mailing Address - Fax:302-832-5407
Practice Address - Street 1:2575 GLASGOW AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-4747
Practice Address - Country:US
Practice Address - Phone:302-832-5400
Practice Address - Fax:302-832-5407
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELJ-0000159363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DERXAPN3142OtherPRESCRIPTIVE AUTHORITY