Provider Demographics
NPI:1164894432
Name:KOPP, CHRISTINA R (FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:R
Last Name:KOPP
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:R
Other - Last Name:BYRNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2510 CORRIDOR WAY STE 6A
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-7604
Mailing Address - Country:US
Mailing Address - Phone:319-384-8500
Mailing Address - Fax:
Practice Address - Street 1:2510 CORRIDOR WAY STE 6A
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-7604
Practice Address - Country:US
Practice Address - Phone:319-384-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013230363LP2300X
IAA151253363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL920540OtherMEDICARE PTAN GROUP
ILF400286769OtherMEDICARE PTAN INDIVIDUAL