Provider Demographics
NPI:1346432770
Name:KOOPMAN, ANNA C (CRNP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:C
Last Name:KOOPMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MARKET ST FL 30
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2934
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:856-922-9890
Practice Address - Street 1:1200 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3720
Practice Address - Country:US
Practice Address - Phone:215-481-6784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-113403363L00000X
PASP022800363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051544706OtherBCBS
AL051544708OtherBCBS
AL891017599Medicaid
AL891017600Medicaid
AL891017601Medicaid
AL051544714OtherBCBS
AL051544715OtherBCBS
AL891017606Medicaid
AL051544710OtherBCBS
AL891017595Medicaid
AL891017593Medicaid
AL051544705OtherBCBS
AL510I500035OtherMEDICARE
AL891017592Medicaid
AL051544711OtherBCBS
AL891017598Medicaid
AL051544709OtherBCBS
AL891017594Medicaid
AL051544707OtherBCBS
AL051544712OtherBCBS