Provider Demographics
NPI:1285804856
Name:COPLIN, MARY E (FNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:COPLIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636372
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:419-226-9120
Mailing Address - Fax:419-996-5410
Practice Address - Street 1:1800 E 5TH ST
Practice Address - Street 2:
Practice Address - City:DELPHOS
Practice Address - State:OH
Practice Address - Zip Code:45833-9180
Practice Address - Country:US
Practice Address - Phone:419-996-5030
Practice Address - Fax:419-996-5458
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP99471363LC1500X
OHCOA.07555363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2440513Medicaid
OHCONP13962Medicare PIN
OHH166040Medicare PIN