Individual
LAUREL KATHERINE HALLOCK KOPPELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
12720 SE DIVISION STREET, PORTLAND, OR 97236
(503) 988-3601
Mailing address
421 SW OAK ST, STE. 210, PORTLAND, OR 97204-1817
(503) 988-7468
(503) 988-3015
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201392556
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
096511
—
OR
05
—
22959
—
OR
Enumeration date
01/30/2014
Last updated
04/23/2014
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