Provider Demographics
NPI:1508176173
Name:COOPER, ABIGAIL OLIVIA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:ABIGAIL
Middle Name:OLIVIA
Last Name:COOPER
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 1:915 S MIAMI ST
Mailing Address - Street 2:
Mailing Address - City:WEST MILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45383-1214
Mailing Address - Country:US
Mailing Address - Phone:937-719-3060
Mailing Address - Fax:
Practice Address - Street 1:915 S MIAMI ST
Practice Address - Street 2:
Practice Address - City:WEST MILTON
Practice Address - State:OH
Practice Address - Zip Code:45383-1214
Practice Address - Country:US
Practice Address - Phone:937-719-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.139892-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse