Provider Demographics
NPI:1073916219
Name:COOPER, LENNIA
Entity Type:Individual
Prefix:
First Name:LENNIA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3849 AIRPORT HWY APT 6
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-7132
Mailing Address - Country:US
Mailing Address - Phone:567-315-5960
Mailing Address - Fax:
Practice Address - Street 1:3849 AIRPORT HWY APT 6
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7132
Practice Address - Country:US
Practice Address - Phone:567-315-5960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH371993630392376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide