Provider Demographics
NPI:1386286201
Name:HOWELL, MICHELLE RENEE (FNP-BC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:HOWELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 TWY HWY 300
Mailing Address - Street 2:
Mailing Address - City:HAMMONDSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 N MARKET ST STE B
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-1146
Practice Address - Country:US
Practice Address - Phone:330-870-4595
Practice Address - Fax:330-870-4189
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH338129363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0379337Medicaid