Provider Demographics
NPI:1124625322
Name:COLE, LAMARCUS L
Entity type:Individual
Prefix:
First Name:LAMARCUS
Middle Name:L
Last Name:COLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 4TH ST APT 17
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742-2133
Mailing Address - Country:US
Mailing Address - Phone:563-223-3642
Mailing Address - Fax:
Practice Address - Street 1:236 4TH ST APT 17
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742-2133
Practice Address - Country:US
Practice Address - Phone:563-223-3642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide