Basic Information
| Provider Information | |||||||||
| NPI: | 1861054157 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COPLIN | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | APRN, CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1702 UNIVERSITY DR S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581034940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013644222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 275 11TH ST S | ||||||||
| Address2: | |||||||||
| City: | WAHPETON | ||||||||
| State: | ND | ||||||||
| PostalCode: | 580754655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7016422000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2019 | ||||||||
| LastUpdateDate: | 07/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R39183 | ND | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.