Basic Information
| Provider Information | |||||||||
| NPI: | 1346432770 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOOPMAN | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 MARKET ST FL 30 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191072934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | 8569229890 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 OLD YORK RD | ||||||||
| Address2: | |||||||||
| City: | ABINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190013720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154816784 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2007 | ||||||||
| LastUpdateDate: | 11/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 1-113403 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LW0102X | SP022800 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 051544706 | 01 | AL | BCBS | OTHER | 051544708 | 01 | AL | BCBS | OTHER | 891017599 | 05 | AL | MEDICAID | 891017600 | 05 | AL | MEDICAID | 891017601 | 05 | AL | MEDICAID | 051544714 | 01 | AL | BCBS | OTHER | 051544715 | 01 | AL | BCBS | OTHER | 891017606 | 05 | AL | MEDICAID | 051544710 | 01 | AL | BCBS | OTHER | 891017595 | 05 | AL | MEDICAID | 891017593 | 05 | AL | MEDICAID | 051544705 | 01 | AL | BCBS | OTHER | 510I500035 | 01 | AL | MEDICARE | OTHER | 891017592 | 05 | AL | MEDICAID | 051544711 | 01 | AL | BCBS | OTHER | 891017598 | 05 | AL | MEDICAID | 051544709 | 01 | AL | BCBS | OTHER | 891017594 | 05 | AL | MEDICAID | 051544707 | 01 | AL | BCBS | OTHER | 051544712 | 01 | AL | BCBS | OTHER |