Provider Demographics
NPI:1770715880
Name:COPPOLA, JEANINE (RN)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:
Last Name:COPPOLA
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 1:114 STANLEY DR
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2232
Mailing Address - Country:US
Mailing Address - Phone:631-585-3561
Mailing Address - Fax:
Practice Address - Street 1:114 STANLEY DR
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2232
Practice Address - Country:US
Practice Address - Phone:631-585-3561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-23
Last Update Date:2009-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35874-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse