Provider Demographics
NPI:1376780767
Name:LAUREANO, KAREN RUTH (LPN)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:RUTH
Last Name:LAUREANO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 E BROADWAY ST TRLR 104
Mailing Address - Street 2:
Mailing Address - City:NORTH BALTIMORE
Mailing Address - State:OH
Mailing Address - Zip Code:45872-9585
Mailing Address - Country:US
Mailing Address - Phone:419-957-7622
Mailing Address - Fax:
Practice Address - Street 1:930 EAST BROADWAY ST LOT 104
Practice Address - Street 2:
Practice Address - City:NORTH BALTIMORE
Practice Address - State:OH
Practice Address - Zip Code:45872-4242
Practice Address - Country:US
Practice Address - Phone:419-957-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN075759164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2885874Medicaid