Provider Demographics
NPI:1952665366
Name:KOPUNEK, SUSAN PODRAZA (CRNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:PODRAZA
Last Name:KOPUNEK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S CATON AVE
Mailing Address - Street 2:MS 235
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5201
Mailing Address - Country:US
Mailing Address - Phone:667-234-8777
Mailing Address - Fax:667-234-3517
Practice Address - Street 1:900 S CATON AVE
Practice Address - Street 2:MS 235
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5201
Practice Address - Country:US
Practice Address - Phone:667-234-8777
Practice Address - Fax:667-234-3517
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR120298363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health