Provider Demographics
NPI:1821752916
Name:KOPFER, JORDAN RACHEL (PA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:RACHEL
Last Name:KOPFER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-4038
Mailing Address - Country:US
Mailing Address - Phone:651-331-1960
Mailing Address - Fax:
Practice Address - Street 1:6545 FRANCE AVE S STE 165
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2118
Practice Address - Country:US
Practice Address - Phone:952-920-6545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13883363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant