Provider Demographics
NPI:1457655276
Name:COPHER, MELINDA JEAN (LPN)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:JEAN
Last Name:COPHER
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 1:2213 VALE DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-3554
Mailing Address - Country:US
Mailing Address - Phone:937-469-7393
Mailing Address - Fax:
Practice Address - Street 1:2213 VALE DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-3554
Practice Address - Country:US
Practice Address - Phone:937-469-7393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-08
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.133393-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse