Provider Demographics
NPI:1124499926
Name:COOLEY, LACOYA (LPN)
Entity type:Individual
Prefix:MRS
First Name:LACOYA
Middle Name:
Last Name:COOLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LACOYA
Other - Middle Name:
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:445 ELMWOOD TER
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3709
Mailing Address - Country:US
Mailing Address - Phone:585-278-4831
Mailing Address - Fax:
Practice Address - Street 1:77 WILLITE DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-5123
Practice Address - Country:US
Practice Address - Phone:585-278-4831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
342000000X
NY323924164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No342000000XTransportation ServicesTransportation Network Company
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY201974473Medicaid