1346432770 NPI number — ANNA C KOOPMAN CRNP

Table of content: ANNA C KOOPMAN CRNP (NPI 1346432770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346432770 NPI number — ANNA C KOOPMAN CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOOPMAN
Provider First Name:
ANNA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346432770
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 MARKET ST FL 30
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107-2934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
856-922-9890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 OLD YORK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19001-3720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-481-6784
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  1-113403 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LW0102X , with the licence number: SP022800 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 051544706 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051544708 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 891017599 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 891017600 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 891017601 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051544714 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051544715 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 891017606 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051544710 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 891017595 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 891017593 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051544705 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 510I500035 . This is a "MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 891017592 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051544711 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 891017598 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051544709 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 891017594 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051544707 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051544712 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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