Provider Demographics
NPI:1053628222
Name:COOMER, ALETTA MICHELLE (LPN)
Entity type:Individual
Prefix:
First Name:ALETTA
Middle Name:MICHELLE
Last Name:COOMER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ALETTA
Other - Middle Name:MICHELLE
Other - Last Name:FARRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:111 SNIDER CT
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1348
Mailing Address - Country:US
Mailing Address - Phone:513-600-8555
Mailing Address - Fax:
Practice Address - Street 1:111 SNIDER CT
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1348
Practice Address - Country:US
Practice Address - Phone:513-600-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-100745164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse