Individual
AUTUMN ROSE KOPPENHAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
4897 STATE ROUTE 209, ELIZABETHVILLE, PA 17023-8455
(717) 362-3371
(717) 362-4278
Mailing address
7 DOCK HILL RD, MIDDLEBURG, PA 17842-8910
(570) 837-2123
(570) 837-2185
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
SP033234
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1045211160001
—
PA
Enumeration date
07/16/2025
Last updated
08/04/2025
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