Healthcare Provider Details

I. General information

NPI: 1699548644
Provider Name (Legal Business Name): LAUREN COLSTON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4466 LYNNHAVEN AVE
LOUISVILLE OH
44641-9513
US

IV. Provider business mailing address

5251 TANGLEWOOD DR NE
LOUISVILLE OH
44641-8805
US

V. Phone/Fax

Practice location:
  • Phone: 330-875-5060
  • Fax:
Mailing address:
  • Phone: 614-955-0246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0035283
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: