1386204097 NPI number — MRS. CHEYENNA LYNNE KOPACZ DNP FNP-C

Table of content: MRS. CHEYENNA LYNNE KOPACZ DNP FNP-C (NPI 1386204097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386204097 NPI number — MRS. CHEYENNA LYNNE KOPACZ DNP FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOPACZ
Provider First Name:
CHEYENNA
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DNP FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KAWAL
Provider Other First Name:
CHEYENNA
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386204097
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
#1098 2501 W HAPPY VALLEY RD
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-489-4958
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#1098 2501 W HAPPY VALLEY RD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-489-4958
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2019

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:  227570 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Z229839 . This is a "MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 533013 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com