Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 021663 | OH |
NPI | 1043738149 |
---|---|
Provider Name | Maryann Christine Matthews |
First Address | Mentor, OH 44060-5318 |
Second Address | Mentor, OH 44060 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2017 |
Last Update Date | 18/08/2021 |