MEDICARE: MICHELLE CRUMPLEY-GROOMES RN

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	163W00000X	Registered Nurse	417472	OH

General Provider Information

NPI Number	:	1740739036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE CRUMPLEY-GROOMES RN

Provider Business Mailing Address
First Line	:	5727 LANTANA AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-3013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5727 LANTANA AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-3013
Country	:	US
Telephone Number	:	513-609-9237
Fax Number	:

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

Provider Enumeration Date	:	09/27/2016
Last Update Date	:	09/27/2016

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