Provider Demographics
NPI:1609393818
Name:LAUDICK, JUSTIN DONALD (BSN-RN, NP-C)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:DONALD
Last Name:LAUDICK
Suffix:
Gender:M
Credentials:BSN-RN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:290 EAST 3RD STREET
Practice Address - Street 2:
Practice Address - City:OTTOVILLE
Practice Address - State:OH
Practice Address - Zip Code:45876
Practice Address - Country:US
Practice Address - Phone:419-453-3321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.354086163WE0003X
OH132516207PE0004X
OHAPRN.CNP.024177363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner