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Individual

DANA MARIE KOPACZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
15125 22 MILE RD, SHELBY TOWNSHIP, MI 48315-4406
(586) 532-0599
Mailing address
9794 HILLCREST DR, PLYMOUTH, MI 48170-3236
(248) 990-2459

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
4704300032
MI

Other

Enumeration date
12/05/2019
Last updated
12/05/2019
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