Provider Demographics
NPI:1235624057
Name:COPELAND, MAUREEN NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:NICOLE
Last Name:COPELAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:MCGARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1860 HOWE AVE STE 440
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-1098
Mailing Address - Country:US
Mailing Address - Phone:916-569-8484
Mailing Address - Fax:
Practice Address - Street 1:1276 HALYARD DR
Practice Address - Street 2:
Practice Address - City:W SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3412
Practice Address - Country:US
Practice Address - Phone:916-454-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009275363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health