Provider Demographics
NPI:1235674284
Name:CARDIMEN, MICHELLE M
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:M
Last Name:CARDIMEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:M
Other - Last Name:LENTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:14917 POLLARD DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-7916
Mailing Address - Country:US
Mailing Address - Phone:317-414-5984
Mailing Address - Fax:
Practice Address - Street 1:14917 POLLARD DR
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-7916
Practice Address - Country:US
Practice Address - Phone:317-414-5984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28146656A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0OtherNOT APPLICABLE