Healthcare Provider Details

I. General information

NPI: 1932442324
Provider Name (Legal Business Name): LAUREN MARIE BALUCH CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. LAUREN MARIE NABEREZNY

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7630 SOUTHERN BLVD
YOUNGSTOWN OH
44512
US

IV. Provider business mailing address

7630 SOUTHERN BLVD
YOUNGSTOWN OH
44512-5633
US

V. Phone/Fax

Practice location:
  • Phone: 330-729-8011
  • Fax: 330-729-8084
Mailing address:
  • Phone: 330-729-8011
  • Fax: 330-729-8084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN337180
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number91437
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: