Provider Demographics
NPI:1568588150
Name:KOPPLIN, FAYE MARIA (NP)
Entity Type:Individual
Prefix:MISS
First Name:FAYE
Middle Name:MARIA
Last Name:KOPPLIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4314 W CRYSTAL LAKE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-4211
Mailing Address - Country:US
Mailing Address - Phone:815-344-2300
Mailing Address - Fax:815-344-2334
Practice Address - Street 1:4314 W CRYSTAL LAKE RD
Practice Address - Street 2:SUITE D
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4211
Practice Address - Country:US
Practice Address - Phone:815-344-2300
Practice Address - Fax:815-344-2334
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL309002005363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q45354Medicare UPIN