Provider Demographics
NPI:1467409896
Name:TWOMBLY, MICHELLE LEE (CNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:TWOMBLY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 EMERALD LAKES DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-7443
Mailing Address - Country:US
Mailing Address - Phone:330-241-4317
Mailing Address - Fax:
Practice Address - Street 1:3780 MEDINA RD
Practice Address - Street 2:SUITE 310
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-5947
Practice Address - Country:US
Practice Address - Phone:330-725-8441
Practice Address - Fax:330-725-8442
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-07063363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2356123Medicaid
OHTWNP11462Medicare ID - Type Unspecified
OH2356123Medicaid