Provider Demographics
NPI:1417426081
Name:COLES, INEZ SUSIE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:INEZ
Middle Name:SUSIE
Last Name:COLES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1856 SURREY TRL APT 7
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-2727
Mailing Address - Country:US
Mailing Address - Phone:937-782-8227
Mailing Address - Fax:
Practice Address - Street 1:1856 SURREY TRL APT 7
Practice Address - Street 2:
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305-2727
Practice Address - Country:US
Practice Address - Phone:937-782-8227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH157691.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse