Provider Demographics
NPI:1982837191
Name:COLE, CHRISTIE MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:CHRISTIE
Middle Name:MARIE
Last Name:COLE
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 1:14 DUCHESS LN
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-3209
Mailing Address - Country:US
Mailing Address - Phone:419-618-4381
Mailing Address - Fax:567-220-6072
Practice Address - Street 1:14 DUCHESS LN
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-3209
Practice Address - Country:US
Practice Address - Phone:419-618-4381
Practice Address - Fax:567-220-6072
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN112181164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse