Provider Demographics
NPI:1710659933
Name:KOPCHINSKY, MARYROSE (RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:MARYROSE
Middle Name:
Last Name:KOPCHINSKY
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8204 BUENA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-7306
Mailing Address - Country:US
Mailing Address - Phone:704-840-2061
Mailing Address - Fax:
Practice Address - Street 1:8204 BUENA VISTA DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-7306
Practice Address - Country:US
Practice Address - Phone:704-840-2061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207059163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant