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NPI Code Detail

MEDICARE: COLLEEN MATHEWS RD

MEDICARE: COLLEEN MATHEWS RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133VN1004XPediatric Nutrition Registered Dietitian6075OH

General Provider Information

NPI Number : 1376781617
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLLEEN MATHEWS RD
Provider Business Mailing Address
First Line : 1430 MAPLE AVE
Second Line :
City : WYOMING
State : OH
Zip : 45215-2116
Country : US
Telephone Number : 513-218-3815
Fax Number :
Provider Business Practice Location Address
First Line : 1430 MAPLE AVE
Second Line :
City : WYOMING
State : OH
Zip : 45215-2116
Country : US
Telephone Number : 513-218-3815
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2009
Last Update Date : 01/24/2009

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