Individual
GERALDINE S. KOPPENAAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RNCS
Contact information
Practice address
106 WEST FOSTER STREET, MELROSE, MA 02176
(781) 665-4295
Mailing address
106 W FOSTER ST, MELROSE, MA 02176-3813
(781) 665-4295
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
116810
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0036916
NEIGHBORHOOD HEALTH PLAN
MA
01
—
PN0658
BLUE CROSS
MA
Enumeration date
05/24/2006
Last updated
10/08/2009
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