Provider Demographics
NPI:1801140165
Name:KOPPELMAN, ERIN NICOLE (NP)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:NICOLE
Last Name:KOPPELMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:NICOLE
Other - Last Name:ROTENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:4120 W MAPLE RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3010
Mailing Address - Country:US
Mailing Address - Phone:248-672-6107
Mailing Address - Fax:
Practice Address - Street 1:4120 W MAPLE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-3010
Practice Address - Country:US
Practice Address - Phone:248-672-6107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704265741363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care