Provider Demographics
NPI:1891264909
Name:COOPER, YALESIA NICOLE (LPN)
Entity Type:Individual
Prefix:
First Name:YALESIA
Middle Name:NICOLE
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 1:5918 OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-1832
Mailing Address - Country:US
Mailing Address - Phone:440-453-8981
Mailing Address - Fax:440-848-8894
Practice Address - Street 1:5918 OLIVE AVE
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-1832
Practice Address - Country:US
Practice Address - Phone:440-453-8981
Practice Address - Fax:440-848-8894
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH183665164W00000X
OH400361770504374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0275647Medicaid