Provider Demographics
NPI:1689479487
Name:KOPPIT, CARLY TERESA
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:TERESA
Last Name:KOPPIT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:TERESA
Other - Last Name:GLUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13304 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3453
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13304 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3453
Practice Address - Country:US
Practice Address - Phone:402-208-5929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion