Healthcare Provider Details

I. General information

NPI: 1356747562
Provider Name (Legal Business Name): LAUREN WESTFALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2014
Last Update Date: 11/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 REMICK BLVD
SPRINGBORO OH
45066-9168
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
MIDDLETOWN OH
45005-2584
US

V. Phone/Fax

Practice location:
  • Phone: 937-888-1511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number002971
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: