Provider Demographics
NPI:1437688744
Name:KOHLER, JADEE LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:JADEE
Middle Name:LYNN
Last Name:KOHLER
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 1:973 ROUTE 67
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:NY
Mailing Address - Zip Code:12451-1227
Mailing Address - Country:US
Mailing Address - Phone:518-929-1883
Mailing Address - Fax:
Practice Address - Street 1:973 ROUTE 67
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:NY
Practice Address - Zip Code:12451-1227
Practice Address - Country:US
Practice Address - Phone:518-929-1883
Practice Address - Fax:518-929-1883
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256671-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty