Provider Demographics
NPI:1982740866
Name:COPILOW, JANE AMBER (RNP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:AMBER
Last Name:COPILOW
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WAVECREST AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-3369
Mailing Address - Country:US
Mailing Address - Phone:310-392-3287
Mailing Address - Fax:
Practice Address - Street 1:1711 OCEAN PARK BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-4901
Practice Address - Country:US
Practice Address - Phone:310-450-4773
Practice Address - Fax:310-450-0873
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA377033363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology