Provider Demographics
NPI:1518974633
Name:KOPYTKO, EDWIN EDWARD (MS, RN, CNS)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:EDWARD
Last Name:KOPYTKO
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Gender:M
Credentials:MS, RN, CNS
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Mailing Address - Street 1:8918 OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-4967
Mailing Address - Country:US
Mailing Address - Phone:708-202-8387
Mailing Address - Fax:708-202-4562
Practice Address - Street 1:FIFTH AVENUE AND ROOSEVELT ROAD
Practice Address - Street 2:
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-8387
Practice Address - Fax:708-202-4572
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult