Provider Demographics
NPI:1780200220
Name:KOPP, HEATHER LYNN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:KOPP
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 CAROLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3696
Mailing Address - Country:US
Mailing Address - Phone:814-335-0258
Mailing Address - Fax:
Practice Address - Street 1:237 CAROLWOOD RD
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3696
Practice Address - Country:US
Practice Address - Phone:814-335-0258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-21
Last Update Date:2020-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency