Provider Demographics
NPI:1225151012
Name:CLARK, LAURA S (RN, CNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:S
Last Name:CLARK
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:DIGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNP
Mailing Address - Street 1:3333 BURNET AVE.
Mailing Address - Street 2:ML 11013
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-1422
Mailing Address - Fax:513-636-3220
Practice Address - Street 1:3333 BURNET AVE.
Practice Address - Street 2:ML 11013
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-1422
Practice Address - Fax:513-636-3220
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.07217-NP363L00000X
OHAPRN.CNP.07217363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner