Provider Demographics
NPI:1780900332
Name:CAMBONI, MICHELLE RENE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENE
Last Name:CAMBONI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:RENE
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4020 LEATHER STOCKING TRL
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1525
Mailing Address - Country:US
Mailing Address - Phone:614-595-1187
Mailing Address - Fax:
Practice Address - Street 1:4020 LEATHER STOCKING TRL
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1525
Practice Address - Country:US
Practice Address - Phone:614-595-1187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN294989163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse