Healthcare Provider Details

I. General information

NPI: 1407412117
Provider Name (Legal Business Name): LAUREN ANN BRUWER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2019
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

1530 SPRING GARDEN AVE
LAKEWOOD OH
44107-3442
US

V. Phone/Fax

Practice location:
  • Phone: 216-636-6803
  • Fax:
Mailing address:
  • Phone: 216-385-5364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberLE-00028035
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: