Provider Demographics
NPI:1144394735
Name:GOPLEN, DEBRA LYNN (LPN)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LYNN
Last Name:GOPLEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21002 BUCK RUN LN
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-8650
Mailing Address - Country:US
Mailing Address - Phone:608-647-2190
Mailing Address - Fax:
Practice Address - Street 1:24096 HWY Z
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581
Practice Address - Country:US
Practice Address - Phone:608-647-1137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2243824Medicaid