Provider Demographics
NPI:1285261008
Name:COPELAND, JACQUELINE D
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:D
Last Name:COPELAND
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 1:5319 PARRISH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-1440
Mailing Address - Country:US
Mailing Address - Phone:215-668-0982
Mailing Address - Fax:
Practice Address - Street 1:5319 PARRISH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-1440
Practice Address - Country:US
Practice Address - Phone:215-668-0982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA822266251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health