Provider Demographics
NPI:1114276268
Name:COOPER, BENJAMIN (LPN)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:COOPER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1255
Mailing Address - Country:US
Mailing Address - Phone:740-971-1797
Mailing Address - Fax:
Practice Address - Street 1:369 N UNION ST
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1255
Practice Address - Country:US
Practice Address - Phone:740-971-1797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.136658-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse