Provider Demographics
NPI:1124670633
Name:KOPA, COLLETTE E (RN,MSN)
Entity type:Individual
Prefix:
First Name:COLLETTE
Middle Name:E
Last Name:KOPA
Suffix:
Gender:F
Credentials:RN,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18433-2119
Mailing Address - Country:US
Mailing Address - Phone:570-947-8335
Mailing Address - Fax:
Practice Address - Street 1:851 COMMERCE BLVD STE 107
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1762
Practice Address - Country:US
Practice Address - Phone:570-489-5561
Practice Address - Fax:570-489-5563
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN522740L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse