Healthcare Provider Details

I. General information

NPI: 1538370606
Provider Name (Legal Business Name): MARY ANN MATTHEIS BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 ORPHANAGE RD
FT MITCHELL KY
41017-3006
US

IV. Provider business mailing address

8493 KROTH LN
UNION KY
41091-9747
US

V. Phone/Fax

Practice location:
  • Phone: 859-331-0880
  • Fax:
Mailing address:
  • Phone: 859-384-9484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: