Mark W Koppenberg, R.N.

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

R186537-0 Issued in MN

Practice address

6461 - Lyndale Ave So
Richfield, MN 55423

Phone

(612) 861-4272

Fax

(612) 605-0078

NPI assigned

Apr 3, 2013

Sex

Male

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

The complete record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1364947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364947200000",
    "number": "1306189840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6461 - LYNDALE AVE SO",
            "address_2": "CRYSTAL CARE HOME HEALTH",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "55423",
            "telephone_number": "612-861-4272",
            "fax_number": "612-605-0078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6461 - LYNDALE AVE SO",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "55423",
            "telephone_number": "612-861-4272",
            "fax_number": "612-605-0078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPPENBERG",
        "first_name": "MARK",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "R.N.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-03",
        "last_updated": "2013-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "R186537-0",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Richfield, MN
• Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.