Healthcare Provider Details

I. General information

NPI: 1003764069
Provider Name (Legal Business Name): LAUREN MAE POKONOSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W 10TH AVE
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

929 GILBERT ST
COLUMBUS OH
43206-1522
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN.542685
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: