Provider Demographics
NPI:1316096969
Name:COURSON, JANET ROSE (LPN)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:ROSE
Last Name:COURSON
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 1:714 KNOLLS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050
Mailing Address - Country:US
Mailing Address - Phone:740-507-4081
Mailing Address - Fax:
Practice Address - Street 1:714 KNOLLS DRIVE
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050
Practice Address - Country:US
Practice Address - Phone:740-507-4081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN041329164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2634420Medicaid