Individual
MRS. LANA MAY COPPERNOLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EFDA, CDA
Contact information
Practice address
2053 NW FARGO CT, CAMAS, WA 98607
(380) 833-4505
Mailing address
2053 NW FARGO CT, CAMAS, WA 98607-7953
(380) 833-4505
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
868
KAISER PERMENTE DENTAL
WA
Enumeration date
08/20/2006
Last updated
07/08/2007
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