Provider Demographics
NPI:1902615388
Name:COPPLE, AMANDA ANN
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:ANN
Last Name:COPPLE
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 1:1230 N SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3129
Mailing Address - Country:US
Mailing Address - Phone:402-984-8809
Mailing Address - Fax:
Practice Address - Street 1:1230 N SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3129
Practice Address - Country:US
Practice Address - Phone:402-984-8809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion