Provider Demographics
NPI:1912298977
Name:KOLI, ALICE M (LPN)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:M
Last Name:KOLI
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 1:3259 LAUREN FIELDS DR S
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-9143
Mailing Address - Country:US
Mailing Address - Phone:614-783-8781
Mailing Address - Fax:
Practice Address - Street 1:3259 LAUREN FIELDS DR S
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-9143
Practice Address - Country:US
Practice Address - Phone:614-783-8781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH143353164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse