Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 35.127273 | OH |
N | 2080P0204X | Pediatric Emergency Doctor | 35.127273 | OH |
Y | 2080P0216X | Pediatric Rheumatologist | 35.127273 | OH |
NPI | 1801214648 |
---|---|
Provider Name | Laura R Pratt |
First Address | Columbus, OH 43205-2664 |
Second Address | Omaha, NE 68114-4113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2014 |
Last Update Date | 05/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0249384 | (05) | OH |
H731550 | CGS - MEDICARE (01) | OH |