MEDICARE: MICHELLE LEE TWOMBLY CNP

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	363LF0000X	Family Nurse Practitioner	NP-07063	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467409896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LEE TWOMBLY CNP

Provider Business Mailing Address
First Line	:	6110 EMERALD LAKES DR
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-7443
Country	:	US
Telephone Number	:	330-241-4317
Fax Number	:

Provider Business Practice Location Address
First Line	:	3780 MEDINA RD
Second Line	:	SUITE 310
City	:	MEDINA
State	:	OH
Zip	:	44256-5947
Country	:	US
Telephone Number	:	330-725-8441
Fax Number	:	330-725-8442

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	12/23/2010

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