Provider Demographics
NPI:1124852736
Name:BLEVINS, LAUREN BETH
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:BETH
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4833 TEALTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-9736
Mailing Address - Country:US
Mailing Address - Phone:937-763-8898
Mailing Address - Fax:
Practice Address - Street 1:4221 MALSBARY RD STE 102
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-5521
Practice Address - Country:US
Practice Address - Phone:513-241-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant