Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | NP05347 | OH |
NPI | 1003808510 |
---|---|
Provider Name | Karen E Koplin |
First Address | Fairlawn, OH 44333-3124 |
Second Address | Fairlawn, OH 44333-3124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 08/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2487241 | (05) | OH |
Q14947 | (02) | OH |