Provider Demographics
NPI:1033650122
Name:CARDWELL, MICHELLE (FNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CARDWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 ABRAHAM FLEXNER WAY
Mailing Address - Street 2:OUTPATIENT CARE CENTER - ENDOSCOPY UNIT
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1882
Mailing Address - Country:US
Mailing Address - Phone:502-587-4011
Mailing Address - Fax:502-587-4334
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:OUTPATIENT CARE CENTER - ENDOSCOPY UNIT
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1882
Practice Address - Country:US
Practice Address - Phone:502-587-4011
Practice Address - Fax:502-587-4334
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010896363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily