Provider Demographics
NPI:1144025487
Name:COFFEY, LOLA JOANN (LPN)
Entity type:Individual
Prefix:
First Name:LOLA
Middle Name:JOANN
Last Name:COFFEY
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 1:16280 RIVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NE
Mailing Address - Zip Code:68870-7061
Mailing Address - Country:US
Mailing Address - Phone:308-440-1146
Mailing Address - Fax:
Practice Address - Street 1:1811 W 2ND ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5413
Practice Address - Country:US
Practice Address - Phone:308-382-1884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22345164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse