Provider Demographics
NPI:1194298547
Name:KOHLER, BETH (LPN)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:KOHLER
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 1:8406 MIDDLE RUN RD NE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-9679
Mailing Address - Country:US
Mailing Address - Phone:330-343-6138
Mailing Address - Fax:
Practice Address - Street 1:1194 GRANADA RD NW
Practice Address - Street 2:
Practice Address - City:DELLROY
Practice Address - State:OH
Practice Address - Zip Code:44620-9727
Practice Address - Country:US
Practice Address - Phone:330-705-1605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN092515-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN092515-M-IVMedicaid