Provider Demographics
NPI:1699795153
Name:SCOPA, MARIANNE GERADETTE (MS, APRN, BC)
Entity type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:GERADETTE
Last Name:SCOPA
Suffix:
Gender:F
Credentials:MS, APRN, BC
Other - Prefix:MS
Other - First Name:MARIANNE
Other - Middle Name:GERADETTE
Other - Last Name:SCOPA POYE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, APRN, BC
Mailing Address - Street 1:1441 E BOWEN BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-9727
Mailing Address - Country:US
Mailing Address - Phone:479-443-0279
Mailing Address - Fax:
Practice Address - Street 1:1100 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1944
Practice Address - Country:US
Practice Address - Phone:479-443-4301
Practice Address - Fax:479-587-5914
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR64028163W00000X
ARA01890 ANP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care