Individual
JERIN C COPPENGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2450 RIVERSIDE AVE, MINNEAPOLIS, MN 55454
(612) 672-6000
Mailing address
2450 RIVERSIDE AVE, MINNEAPOLIS, MN 55454-1450
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R 122892-0
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
556518900
—
MN
Enumeration date
02/16/2006
Last updated
06/13/2018
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