Provider Demographics
NPI:1619690682
Name:KOPPELMAN, MARJORY D
Entity Type:Individual
Prefix:
First Name:MARJORY
Middle Name:D
Last Name:KOPPELMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 PINNEY RD
Mailing Address - Street 2:
Mailing Address - City:MOVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51039-7500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:69 PINNEY RD
Practice Address - Street 2:
Practice Address - City:MOVILLE
Practice Address - State:IA
Practice Address - Zip Code:51039-7500
Practice Address - Country:US
Practice Address - Phone:515-402-6621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA171240363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily