Provider Demographics
NPI:1194843110
Name:KOPRIVICA, PATRICIA LYNN (CRNA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:KOPRIVICA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5919 AMBER
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8389
Mailing Address - Country:US
Mailing Address - Phone:517-783-5494
Mailing Address - Fax:517-783-5494
Practice Address - Street 1:5919 AMBER
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-8389
Practice Address - Country:US
Practice Address - Phone:517-783-5494
Practice Address - Fax:517-783-5494
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704170848367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered