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General NPI Number Information
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NPI Number | 1538419643
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Entity Type | Individual
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Provider Name | LAUREN PAUNICKA SOUTHWOOD P.A.
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Gender | Female
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 6620 CLOUGH PIKE
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City | CINCINNATI
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State | OH
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Zip | 45244-4053
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Country | US
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Telephone | 513-232-2663
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Fax | 859-817-7848
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Provider Business Mailing Address
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Address Line | 560 S LOOP RD
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City | EDGEWOOD
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State | KY
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Zip | 41017-3405
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Country | US
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Telephone | 859-301-2663
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Fax | 859-817-7848
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.003600
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License Number State | OH
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