Provider Demographics
NPI:1174254791
Name:HERRICK, LAUREN PIPER (PA)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:PIPER
Last Name:HERRICK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10506A MONTGOMERY ROAD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4400
Mailing Address - Country:US
Mailing Address - Phone:513-246-2400
Mailing Address - Fax:513-246-4047
Practice Address - Street 1:10506A MONTGOMERY ROAD
Practice Address - Street 2:SUITE 301
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-4400
Practice Address - Country:US
Practice Address - Phone:513-246-2400
Practice Address - Fax:513-246-4047
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH50.008390RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program