Provider Demographics
NPI:1407464035
Name:COPPERILL, CHRISTI (RN)
Entity Type:Individual
Prefix:
First Name:CHRISTI
Middle Name:
Last Name:COPPERILL
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 1:39 NEVINWOOD PL
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3529
Mailing Address - Country:US
Mailing Address - Phone:631-923-1118
Mailing Address - Fax:
Practice Address - Street 1:39 NEVINWOOD PL
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3529
Practice Address - Country:US
Practice Address - Phone:631-923-1118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY415104-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse