Provider Demographics
NPI:1821744699
Name:CIANCIMINO, MICHELE ANN (HEALTH COACH)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANN
Last Name:CIANCIMINO
Suffix:
Gender:F
Credentials:HEALTH COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 BRIGOLA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-6108
Mailing Address - Country:US
Mailing Address - Phone:702-232-0112
Mailing Address - Fax:
Practice Address - Street 1:68 BRIGOLA ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-6108
Practice Address - Country:US
Practice Address - Phone:702-482-9163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date: