Provider Demographics
NPI:1639211196
Name:COPELAND, LISA ROSE (LPN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ROSE
Last Name:COPELAND
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 1:3308 MIRANDY RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-8644
Mailing Address - Country:US
Mailing Address - Phone:931-537-9303
Mailing Address - Fax:
Practice Address - Street 1:121 S DIXIE AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3401
Practice Address - Country:US
Practice Address - Phone:931-528-2531
Practice Address - Fax:931-526-7451
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000032949164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse