Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 255MA08698600 | NJ |
N | 208600000X | Surgeon | 255MA08698600 | NJ |
Y | 2086S0102X | Surgical Critical Care | 35123573 | OH |
NPI | 1023337763 |
---|---|
Provider Name | Dr. Lauren Audrey Licata |
First Address | Columbus, OH 43202-1559 |
Second Address | Columbus, OH 43210-1240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2010 |
Last Update Date | 02/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0105408 | (05) | OH |