Individual
MRS. SHELLY R COPPOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(703) 776-4001
Mailing address
2724 OMISOL RD, WOODBRIDGE, VA 22192-3829
(571) 220-4654
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
0024177977
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0024177977
NURSE PRACTITIONER
VA
Enumeration date
08/09/2019
Last updated
08/09/2019
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