Provider Demographics
NPI:1851992598
Name:BURGER, LAUREN FAITH
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:FAITH
Last Name:BURGER
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 1:1143 VAN WAY
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-9792
Mailing Address - Country:US
Mailing Address - Phone:937-541-1355
Mailing Address - Fax:
Practice Address - Street 1:1143 VAN WAY
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-9792
Practice Address - Country:US
Practice Address - Phone:937-541-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X
OH5505140372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider