Provider Demographics
NPI:1255451092
Name:KOPP, MARYELLEN (APN)
Entity type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:
Last Name:KOPP
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N CLAYTON ST
Mailing Address - Street 2:MEDICAL OFFICE BLDG 401
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-3165
Mailing Address - Country:US
Mailing Address - Phone:302-421-4800
Mailing Address - Fax:302-421-4189
Practice Address - Street 1:701 N CLAYTON ST
Practice Address - Street 2:MEDICAL OFFICE BLDG 401
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3165
Practice Address - Country:US
Practice Address - Phone:302-421-4800
Practice Address - Fax:302-421-4189
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELB0000150363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner