Provider Demographics
NPI:1629336649
Name:MUSTAIN, LAUREN N
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:N
Last Name:MUSTAIN
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 1:10506 MONTGOMERY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4487
Mailing Address - Country:US
Mailing Address - Phone:513-791-0550
Mailing Address - Fax:513-791-1517
Practice Address - Street 1:10506 MONTGOMERY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4487
Practice Address - Country:US
Practice Address - Phone:513-791-0550
Practice Address - Fax:513-791-1517
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.345669163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse