Healthcare Provider Details

I. General information

NPI: 1578366001
Provider Name (Legal Business Name): KRISTINA MATTMULLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5805 EUCLID AVE
CLEVELAND OH
44103-3715
US

IV. Provider business mailing address

2136 PRESTWICK CT
STREETSBORO OH
44241-6525
US

V. Phone/Fax

Practice location:
  • Phone: 216-675-6614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN.348190
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: