Healthcare Provider Details

I. General information

NPI: 1881302982
Provider Name (Legal Business Name): LAUREN MASTIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4729 STONEWAY DR
COLUMBUS OH
43229-9511
US

IV. Provider business mailing address

4729 STONEWAY DR
COLUMBUS OH
43229-9511
US

V. Phone/Fax

Practice location:
  • Phone: 734-274-1823
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: