Provider Demographics
NPI:1184675324
Name:KOPELSON, KRISTIN AAMODT (MS, RN, NP)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:AAMODT
Last Name:KOPELSON
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Gender:F
Credentials:MS, RN, NP
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Mailing Address - Street 1:1681 COMSTOCK AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5300
Mailing Address - Country:US
Mailing Address - Phone:310-478-3711
Mailing Address - Fax:310-268-4288
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:CARDIOLOGY, 111E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-4288
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA467124/8430363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner