Provider Demographics
NPI:1578711040
Name:COLE, LORA LEA
Entity Type:Individual
Prefix:MRS
First Name:LORA
Middle Name:LEA
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 COGLEY COLE RD
Mailing Address - Street 2:
Mailing Address - City:VEVAY
Mailing Address - State:IN
Mailing Address - Zip Code:47043-9660
Mailing Address - Country:US
Mailing Address - Phone:812-427-4184
Mailing Address - Fax:
Practice Address - Street 1:110 COGLEY COLE RD
Practice Address - Street 2:
Practice Address - City:VEVAY
Practice Address - State:IN
Practice Address - Zip Code:47043-9660
Practice Address - Country:US
Practice Address - Phone:812-427-4184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200902240Medicaid