Provider Demographics
NPI:1134379225
Name:BURNS, LAUREN NICOLE (DO)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:NICOLE
Last Name:BURNS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:330-666-4158
Mailing Address - Fax:330-666-2256
Practice Address - Street 1:3800 EMBASSY PKWY
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-8387
Practice Address - Country:US
Practice Address - Phone:330-666-4158
Practice Address - Fax:330-668-2256
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OH34-009826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3159291Medicaid