Provider Demographics
NPI:1770772139
Name:COOPER, TERRI LEE (LPN)
Entity type:Individual
Prefix:MS
First Name:TERRI
Middle Name:LEE
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 1:5346 SALEM WOODS DR
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-1614
Mailing Address - Country:US
Mailing Address - Phone:937-718-4402
Mailing Address - Fax:
Practice Address - Street 1:5346 SALEM WOODS DR
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-1614
Practice Address - Country:US
Practice Address - Phone:937-718-4402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH117836164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse