Provider Demographics
NPI:1548289101
Name:COPELAND, JOAN (CNS)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:COPELAND
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 W EXCHANGE ST
Mailing Address - Street 2:#225
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1704
Mailing Address - Country:US
Mailing Address - Phone:330-344-4377
Mailing Address - Fax:330-761-2492
Practice Address - Street 1:224 W EXCHANGE ST
Practice Address - Street 2:#225
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1704
Practice Address - Country:US
Practice Address - Phone:330-344-4377
Practice Address - Fax:330-761-2492
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNS 08583364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2640673Medicaid
OH1568632628OtherNPI GROUP # (TYPE II)
OH1568632628OtherNPI GROUP # (TYPE II)
OHQ57062Medicare UPIN