Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 3010781 | KY |
NPI | 1003353434 |
---|---|
Provider Name | Anna Coppol |
First Address | Louisville, KY 40202-1423 |
Second Address | Louisville, KY 40202-1716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2017 |
Last Update Date | 24/01/2017 |