MEDICARE: ANGELA JEAN MATUS APRN

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
1	363LA2200X	Adult Health Nurse Practitioner	APRN.CNP.0034432	OH

General Provider Information

NPI Number	:	1851071682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA JEAN MATUS APRN

Provider Business Mailing Address
First Line	:	18697 BAGLEY RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-3497
Country	:	US
Telephone Number	:	440-816-4100
Fax Number	:	440-816-5719

Provider Business Practice Location Address
First Line	:	18697 BAGLEY RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-3497
Country	:	US
Telephone Number	:	440-816-4100
Fax Number	:	440-816-5719

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2023
Last Update Date	:	07/18/2023

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