Provider Demographics
NPI:1306734421
Name:COPELAND, MACKENZIE NICOLE (RN)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:NICOLE
Last Name:COPELAND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 MATTHIAS AVE NE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-4493
Mailing Address - Country:US
Mailing Address - Phone:330-704-2041
Mailing Address - Fax:
Practice Address - Street 1:10 PENFIELD AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-2912
Practice Address - Country:US
Practice Address - Phone:330-762-6110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH540496163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health