MEDICARE: LAURA ANN BASCO MSN, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	024849	OH

General Provider Information

NPI Number	:	1093375180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ANN BASCO MSN, PMHNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 638269
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-8269
Country	:	US
Telephone Number	:	440-816-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	7265 OLD OAK BLVD
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3342
Country	:	US
Telephone Number	:	440-816-8200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2019
Last Update Date	:	01/18/2021

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