MEDICARE: LORI ELIZABETH COOPER LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	156436	OH

General Provider Information

NPI Number	:	1407589864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI ELIZABETH COOPER LPN

Provider Business Mailing Address
First Line	:	4308 RHODES AVE
Second Line	:
City	:	NEW BOSTON
State	:	OH
Zip	:	45662-5533
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4308 RHODES AVE
Second Line	:
City	:	NEW BOSTON
State	:	OH
Zip	:	45662-5533
Country	:	US
Telephone Number	:	740-773-1141
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2022
Last Update Date	:	07/05/2022

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