Provider Demographics
NPI:1326771841
Name:KOPP, CORRINE
Entity Type:Individual
Prefix:
First Name:CORRINE
Middle Name:
Last Name:KOPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 LEACH ST # 45
Mailing Address - Street 2:
Mailing Address - City:SOLEN
Mailing Address - State:ND
Mailing Address - Zip Code:58570-9610
Mailing Address - Country:US
Mailing Address - Phone:701-301-7370
Mailing Address - Fax:
Practice Address - Street 1:210 LEACH ST
Practice Address - Street 2:
Practice Address - City:SOLEN
Practice Address - State:ND
Practice Address - Zip Code:58570-9610
Practice Address - Country:US
Practice Address - Phone:701-445-3324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant