Provider Demographics
NPI:1154029338
Name:KOPRIVEC, ANNIE ELIZABETH
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:ELIZABETH
Last Name:KOPRIVEC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 53RD ST SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-4370
Mailing Address - Country:US
Mailing Address - Phone:330-605-4772
Mailing Address - Fax:
Practice Address - Street 1:1715 53RD ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706-4370
Practice Address - Country:US
Practice Address - Phone:330-605-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X, 376J00000X
OH343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No376J00000XNursing Service Related ProvidersHomemaker