| NPI | 1306306451 |
|---|---|
| Other Name | STACY KOPPOE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101278732) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: VA 0101278732) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351048892) | |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2024-11-22 |