Healthcare Provider Details

I. General information

NPI: 1821931734
Provider Name (Legal Business Name): LAUREN TUCKER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1353 W 2ND AVE
COLUMBUS OH
43212-3538
US

IV. Provider business mailing address

1353 W 2ND AVE
COLUMBUS OH
43212-3538
US

V. Phone/Fax

Practice location:
  • Phone: 614-725-6030
  • Fax:
Mailing address:
  • Phone: 614-725-6030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number544106
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: