Provider Demographics
NPI:1619288222
Name:KOPIETZ, ERIN N (APRN)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:N
Last Name:KOPIETZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:N
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:3901 PINE LAKE RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5497
Mailing Address - Country:US
Mailing Address - Phone:402-423-4200
Mailing Address - Fax:402-423-4201
Practice Address - Street 1:211 S 23RD ST
Practice Address - Street 2:INSIDE PAMIDA
Practice Address - City:PLATTSMOUTH
Practice Address - State:NE
Practice Address - Zip Code:68048-2903
Practice Address - Country:US
Practice Address - Phone:402-296-5100
Practice Address - Fax:402-296-5107
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111165363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47024OtherBCBS NE
NE099827004Medicare PIN
NENA1466005Medicare PIN