Healthcare Provider Details

I. General information

NPI: 1497237754
Provider Name (Legal Business Name): LAURA NICOLE CHURCHMAN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 S 4TH ST
TIPP CITY OH
45371-1601
US

IV. Provider business mailing address

11 S 4TH ST
TIPP CITY OH
45371-1601
US

V. Phone/Fax

Practice location:
  • Phone: 937-715-5406
  • Fax: 937-506-0105
Mailing address:
  • Phone: 937-715-5406
  • Fax: 937-506-0105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN.CNP.0030562
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN.389456
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: