Individual
LINDSEY DIANE KOPPERUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP,PHN, BSN, ANP-BC
Contact information
Practice address
2315 STOCKTON BLVD, SACRAMENTO, CA 95817-2201
(916) 734-2011
Mailing address
4805 POLO CT, FAIR OAKS, CA 95628-5266
(530) 521-7740
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
10898
CA
363L00000X
Nurse Practitioner
Primary
653636
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20898
CERTIFIED ADULT NURSE PRACTITIONER
CA
01
—
3634
CERTIFIED CLINICAL NURSE SPECIALIST
CA
01
—
653636
REGISTERED NURSE LICENSURE
CA
Enumeration date
01/25/2010
Last updated
01/14/2021
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