Provider Demographics
NPI:1952940660
Name:WHITFIELD, LAUREN MARISSA (CRNA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARISSA
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 YELLOWSTONE CT
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-3145
Mailing Address - Country:US
Mailing Address - Phone:330-207-7855
Mailing Address - Fax:
Practice Address - Street 1:108 YELLOWSTONE CT
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-3145
Practice Address - Country:US
Practice Address - Phone:330-207-7855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH127190367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered