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General NPI Number Information
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NPI Number | 1619416104
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Entity Type | Individual
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Provider Name | MICHELLE L BIZZARRO CNP
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Gender | Female
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Dates
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Enumeration Date | 02/16/2017
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Last Update Date | 11/20/2020
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Provider Practice Location Address
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Address Line | 7700 WASHINGTON VILLAGE DR STE 210
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City | CENTERVILLE
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State | OH
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Zip | 45459-4094
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Country | US
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Telephone | 937-562-2291
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Fax | 937-562-2293
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Provider Business Mailing Address
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Address Line | 7700 WASHINGTON VILLAGE DR STE 210
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City | CENTERVILLE
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State | OH
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Zip | 45459-4094
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Country | US
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Telephone | 937-562-2291
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Fax | 937-562-2293
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.020448
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License Number State | OH
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