Healthcare Provider Details

I. General information

NPI: 1487260683
Provider Name (Legal Business Name): LAUREN ASHLEY PACK BS, RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date: 12/01/2025
Reactivation Date: 10/02/2026

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN.CNP.0042683
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: