Provider Demographics
NPI:1588609713
Name:COOPER, JAMES GEORGE (LPN)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GEORGE
Last Name:COOPER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 WENZ RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-7174
Mailing Address - Country:US
Mailing Address - Phone:419-381-3259
Mailing Address - Fax:
Practice Address - Street 1:1020 WENZ RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7174
Practice Address - Country:US
Practice Address - Phone:419-381-3259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 120157164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2607987Medicaid