Healthcare Provider Details

I. General information

NPI: 1467409896
Provider Name (Legal Business Name): MICHELLE LEE TWOMBLY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 12/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3780 MEDINA RD SUITE 310
MEDINA OH
44256-5947
US

IV. Provider business mailing address

6110 EMERALD LAKES DR
MEDINA OH
44256-7443
US

V. Phone/Fax

Practice location:
  • Phone: 330-725-8441
  • Fax: 330-725-8442
Mailing address:
  • Phone: 330-241-4317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-07063
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: