Basic Information
| Provider Information | |||||||||
| NPI: | 1750481313 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COPANAS | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 49 OLDE LANTERN RD | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031104816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034723412 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7 PROSPECT ST | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030603921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038896147 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2006 | ||||||||
| LastUpdateDate: | 12/05/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 020694-21 | NH | N | Nursing Service Providers | Registered Nurse | 163WP0809X | 020694-23-08 | NH | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult | 363LP0808X | 020694-21 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 40Y001461NH01 | 01 | NH | BLUE CROSS/BLUE SHIELD | OTHER |