Most Relevant Information
Provider Data
| NPI Number: | 1003655481 |
| Provider Name: | JORDAN KOPSHO |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/23/2024 |
| Last Updated: | 05/23/2024 |
Provider Practice Location
875 PERIMETER DR
MOSCOW
ID
838449803
Practice Location Phone/Fax
| Phone: | 2088856111 |
| Fax: |
Provider Mailing Location
1675 CRAB APPLE CIR
WEST RICHLAND
WA
993535099
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |