MEDICARE: MICHELLE PEMPTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	RJ810051	OH

General Provider Information

NPI Number	:	1003680851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE PEMPTON

Provider Business Mailing Address
First Line	:	3633 LYNNFIELD RD # DN
Second Line	:
City	:	SHAKER HTS
State	:	OH
Zip	:	44122-5111
Country	:	US
Telephone Number	:	623-268-7664
Fax Number	:

Provider Business Practice Location Address
First Line	:	3633 LYNNFIELD RD # DN
Second Line	:
City	:	SHAKER HTS
State	:	OH
Zip	:	44122-5111
Country	:	US
Telephone Number	:	623-268-7664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2023
Last Update Date	:	11/13/2023

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Directions to “ MICHELLE PEMPTON ” Practice Location

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