Provider Demographics
NPI:1386204097
Name:KOPACZ, CHEYENNA LYNNE (DNP FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CHEYENNA
Middle Name:LYNNE
Last Name:KOPACZ
Suffix:
Gender:F
Credentials:DNP FNP-C
Other - Prefix:
Other - First Name:CHEYENNA
Other - Middle Name:LYNNE
Other - Last Name:KAWAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:#1098 2501 W HAPPY VALLEY RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085
Mailing Address - Country:US
Mailing Address - Phone:602-489-4958
Mailing Address - Fax:
Practice Address - Street 1:#1098 2501 W HAPPY VALLEY RD
Practice Address - Street 2:SUITE 4
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085
Practice Address - Country:US
Practice Address - Phone:602-489-4958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ227570363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ229839OtherMEDICARE
AZ533013Medicaid