Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 2010011497 | MO |
NPI | 1053637298 |
---|---|
Provider Name | Corinne Ann Coppinger |
First Address | Washington, MO 63090-3135 |
Second Address | Washington, MO 63090-3135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2010 |
Last Update Date | 17/03/2015 |