Provider Demographics
NPI:1134580418
Name:PONTIUS, MICHELLE (RN, BSN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PONTIUS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CHILDRENS DR
Mailing Address - Street 2:COMPREHENSIVE CP PROGRAM
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2664
Mailing Address - Country:US
Mailing Address - Phone:614-722-5869
Mailing Address - Fax:614-355-4439
Practice Address - Street 1:700 CHILDRENS DR
Practice Address - Street 2:COMPREHENSIVE CP PROGRAM
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2664
Practice Address - Country:US
Practice Address - Phone:614-722-5869
Practice Address - Fax:614-355-4439
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN368199163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care