Healthcare Provider Details

I. General information

NPI: 1588446736
Provider Name (Legal Business Name): MORGAN MCKENZIE MATLICK CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

2426 VALLEY VIEW LN
NEW PHILADELPHIA OH
44663-8851
US

V. Phone/Fax

Practice location:
  • Phone: 216-541-1758
  • Fax:
Mailing address:
  • Phone: 330-447-1194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0035179
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0035179
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN.CNP.0035179
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: