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Individual

MR. MARK W KOPPENBERG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
R.N.

Contact information

Practice address
6461 - LYNDALE AVE SO, RICHFIELD, MN 55423
(612) 861-4272
(612) 605-0078
Mailing address
6461 - LYNDALE AVE SO, CRYSTAL CARE HOME HEALTH, RICHFIELD, MN 55423
(612) 861-4272
(612) 605-0078

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R186537-0
MN

Other

Enumeration date
04/03/2013
Last updated
04/03/2013
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