Healthcare Provider Details

I. General information

NPI: 1669955910
Provider Name (Legal Business Name): LAUREN MICHELLE SMITH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN GRANT

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 PROSPECT PL
CINCINNATI OH
45229-2916
US

IV. Provider business mailing address

636 PROSPECT PL
CINCINNATI OH
45229-2916
US

V. Phone/Fax

Practice location:
  • Phone: 513-363-5522
  • Fax: 513-363-5506
Mailing address:
  • Phone: 513-363-5522
  • Fax: 513-363-5506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.022527
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN.CNP.022527
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1669955910
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: