Provider Demographics
NPI:1770574345
Name:KOPANOS, TAYNIN (NP)
Entity type:Individual
Prefix:
First Name:TAYNIN
Middle Name:
Last Name:KOPANOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 UNITY STREET
Mailing Address - Street 2:ICHC
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4429
Mailing Address - Country:US
Mailing Address - Phone:360-676-6177
Mailing Address - Fax:360-527-8778
Practice Address - Street 1:220 UNITY STREET
Practice Address - Street 2:ICHC
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4429
Practice Address - Country:US
Practice Address - Phone:360-676-6177
Practice Address - Fax:360-671-3574
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60225695363LF0000X
CO119635363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily