Provider Demographics
NPI:1366541385
Name:ZAMUDIO, MICHELLE JEANETTE (CNM)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JEANETTE
Last Name:ZAMUDIO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:JEANETTE
Other - Last Name:MCLAUGHLIN-SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 636256
Mailing Address - Street 2:CENTRAL CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5502
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:11590 CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3326
Practice Address - Country:US
Practice Address - Phone:513-648-9077
Practice Address - Fax:513-648-9554
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN#212394 / NM#03398367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0236257Medicaid
OHZANM00384Medicare PIN
OHZANM00383Medicare PIN