Provider Demographics
NPI:1619228319
Name:COPELAND, JAMES MARSHALL (RN)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MARSHALL
Last Name:COPELAND
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 NE KILLINGSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-4342
Mailing Address - Country:US
Mailing Address - Phone:541-908-6189
Mailing Address - Fax:
Practice Address - Street 1:1035 NE KILLINGSWORTH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-4342
Practice Address - Country:US
Practice Address - Phone:541-908-6189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201241654RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse