Provider Demographics
NPI:1932442324
Name:BALUCH, LAUREN MARIE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:MARIE
Last Name:BALUCH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:NABEREZNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7630 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5633
Mailing Address - Country:US
Mailing Address - Phone:330-729-8011
Mailing Address - Fax:330-729-8084
Practice Address - Street 1:7630 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512
Practice Address - Country:US
Practice Address - Phone:330-729-8011
Practice Address - Fax:330-729-8084
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN337180163W00000X
OH91437367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH369340OtherMEDICARE PTAN
OH0111704Medicaid