Provider Demographics
NPI:1245799444
Name:KOOPMAN, MCKENZIE MARIE
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:MARIE
Last Name:KOOPMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5247 N RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PARCHMENT
Mailing Address - State:MI
Mailing Address - Zip Code:49004-1541
Mailing Address - Country:US
Mailing Address - Phone:269-267-9022
Mailing Address - Fax:
Practice Address - Street 1:5247 N RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:PARCHMENT
Practice Address - State:MI
Practice Address - Zip Code:49004-1541
Practice Address - Country:US
Practice Address - Phone:269-267-9022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program