Healthcare Provider Details

I. General information

NPI: 1609327220
Provider Name (Legal Business Name): LAUREN ELIZABETH MALLORY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 SOUTHMEADOW CIR UNIT 101
CINCINNATI OH
45231-6112
US

IV. Provider business mailing address

850 SOUTHMEADOW CIR UNIT 101
CINCINNATI OH
45231-6112
US

V. Phone/Fax

Practice location:
  • Phone: 513-295-9870
  • Fax:
Mailing address:
  • Phone: 513-295-9870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0042164
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: