Provider Demographics
NPI:1801857669
Name:KOPICKO, KAREN ANN (RN, CPNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:KOPICKO
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:CHMIELNICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CPNP
Mailing Address - Street 1:499 LEICESTER ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1067
Mailing Address - Country:US
Mailing Address - Phone:734-459-3402
Mailing Address - Fax:
Practice Address - Street 1:911 BROWN ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-3203
Practice Address - Country:US
Practice Address - Phone:734-769-3702
Practice Address - Fax:734-769-2075
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704113320363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics