Provider Demographics
NPI:1164271896
Name:COPPERSTAD, JUNE
Entity type:Individual
Prefix:
First Name:JUNE
Middle Name:
Last Name:COPPERSTAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUNE
Other - Middle Name:
Other - Last Name:COPPERFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:621 E PRESENTATION ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-0820
Mailing Address - Country:US
Mailing Address - Phone:605-221-2346
Mailing Address - Fax:605-221-2404
Practice Address - Street 1:621 E PRESENTATION ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-0820
Practice Address - Country:US
Practice Address - Phone:605-221-2346
Practice Address - Fax:605-221-2404
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker