Provider Demographics
NPI:1861672016
Name:KOPISHKE, LYNDA RAE (RN)
Entity Type:Individual
Prefix:MS
First Name:LYNDA
Middle Name:RAE
Last Name:KOPISHKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 NORTH EAST ISLES DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901
Mailing Address - Country:US
Mailing Address - Phone:302-528-8484
Mailing Address - Fax:
Practice Address - Street 1:109 NORTH EAST ISLES DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901
Practice Address - Country:US
Practice Address - Phone:302-528-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR057715163WC0400X, 163WH0200X, 163WP0807X, 163WR0400X
DEL10009924171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation