Provider Demographics
NPI:1538191978
Name:KOPEIKA, CHRISTINA F (CNP)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:F
Last Name:KOPEIKA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 ELM PL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2538
Mailing Address - Country:US
Mailing Address - Phone:847-433-0404
Mailing Address - Fax:847-433-1389
Practice Address - Street 1:480 ELM PL
Practice Address - Street 2:SUITE 203
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2538
Practice Address - Country:US
Practice Address - Phone:847-433-0404
Practice Address - Fax:847-433-1389
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-005654363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ50944Medicare UPIN
IL308850Medicare ID - Type UnspecifiedMEDICARE GOUP PROVIDER #