Healthcare Provider Details

I. General information

NPI: 1578487682
Provider Name (Legal Business Name): LANDRY RAY MATHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 S MAIN ST APT 302
FINDLAY OH
45840-3327
US

IV. Provider business mailing address

323 S MAIN ST APT 302
FINDLAY OH
45840-3327
US

V. Phone/Fax

Practice location:
  • Phone: 330-631-8845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: