1699798983 NPI number — LOREN K COPELAND CRNA

Table of content: LOREN K COPELAND CRNA (NPI 1699798983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699798983 NPI number — LOREN K COPELAND CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COPELAND
Provider First Name:
LOREN
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

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:
1699798983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13607 229TH DR SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ISSAQUAH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98027-8477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-614-8124
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6400 SE LAKE RD
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97222-2129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-594-1774
Provider Business Practice Location Address Fax Number:
503-594-1775
Provider Enumeration Date:
07/26/2006

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: 367500000X , with the licence number:  AP30007351 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200860022CRNA . This is a "CRNA" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 200840685RN . This is a "RN" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: AP30007351 . This is a "ARNP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: RN00163428 . This is a "RN LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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