Provider Demographics
NPI:1285336578
Name:TIBERIO, MICHELLE RENEE (CNM)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:TIBERIO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3422 GREENVILLE DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-9180
Mailing Address - Country:US
Mailing Address - Phone:614-572-7965
Mailing Address - Fax:
Practice Address - Street 1:444 N CLEVELAND AVE STE 120
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8388
Practice Address - Country:US
Practice Address - Phone:614-818-0300
Practice Address - Fax:614-818-0313
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNM08065176B00000X
OHAPRN.CNM.0019546367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife