Provider Demographics
NPI:1295281574
Name:PLANCK, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:PLANCK
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 1:555 CINCINNATI BATAVIA PIKE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-1557
Mailing Address - Country:US
Mailing Address - Phone:513-752-1555
Mailing Address - Fax:513-688-8155
Practice Address - Street 1:551 CINCINNATI BATAVIA PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244-1518
Practice Address - Country:US
Practice Address - Phone:513-752-1555
Practice Address - Fax:513-688-8155
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.142256.MEDS.IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse