Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | COA10968-NP | OH |
NPI | 1023335668 |
---|---|
Provider Name | Laura Brake |
First Address | Columbus, OH 43228-9089 |
Second Address | Columbus, OH 43219-1834 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2010 |
Last Update Date | 03/10/2018 |