Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 003719 | OH |
NPI | 1093075020 |
---|---|
Provider Name | Dr. Jamie Lynn Matteo |
First Address | Warren, OH 44484-2473 |
Second Address | Warren, OH 44484-2473 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2012 |
Last Update Date | 30/05/2017 |