MEDICARE: TIANA N COOPER STNA

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	LPN.184732.MEDS-IV	OH

General Provider Information

NPI Number	:	1093430779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIANA N COOPER STNA

Provider Business Mailing Address
First Line	:	3838 WASHINGTON AVE APT 16
Second Line	:
City	:	CHEVIOT
State	:	OH
Zip	:	45211-4649
Country	:	US
Telephone Number	:	513-227-9828
Fax Number	:

Provider Business Practice Location Address
First Line	:	3838 WASHINGTON AVE APT 16
Second Line	:
City	:	CHEVIOT
State	:	OH
Zip	:	45211-4649
Country	:	US
Telephone Number	:	513-227-7546
Fax Number	:

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

Provider Enumeration Date	:	10/05/2022
Last Update Date	:	03/29/2024

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Directions to “ TIANA N COOPER STNA” Practice Location

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