Provider Demographics
NPI:1750997326
Name:COOPER, AMELIA ELIZABETH (LPN)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:ELIZABETH
Last Name:COOPER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:ELIZABETH
Other - Last Name:MOGEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:4600 MONTGOMERY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2210 S RIDGE RD E
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-4459
Practice Address - Country:US
Practice Address - Phone:138-347-0635
Practice Address - Fax:513-873-1567
Is Sole Proprietor?:No
Enumeration Date:2020-09-19
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.140968.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse