Healthcare Provider Details

I. General information

NPI: 1558605857
Provider Name (Legal Business Name): MICHELLE J RUBERTINO RN, MSN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 OLENTANGY RIVER RD
COLUMBUS OH
43214-3908
US

IV. Provider business mailing address

3535 OLENTANGY RIVER RD
COLUMBUS OH
43214-3908
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-2669
  • Fax:
Mailing address:
  • Phone: 614-566-2669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberCOA03666NS
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: