Provider Demographics
NPI:1063010338
Name:CROOK, LAUREN ALEXIS
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALEXIS
Last Name:CROOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1381 FOX FIRE CT
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-4032
Mailing Address - Country:US
Mailing Address - Phone:513-720-7456
Mailing Address - Fax:
Practice Address - Street 1:1381 FOX FIRE CT
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-4032
Practice Address - Country:US
Practice Address - Phone:513-720-7456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016579363L00000X
OHLE-00032229363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner