Healthcare Provider Details

I. General information

NPI: 1861194011
Provider Name (Legal Business Name): HANNAH MATTIX APRN-CNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 10/23/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6480 ROCKSIDE WOODS BLVD S STE 330
INDEPENDENCE OH
44131-2222
US

IV. Provider business mailing address

140 COLONIAL DR
CANFIELD OH
44406-1633
US

V. Phone/Fax

Practice location:
  • Phone: 855-490-9434
  • Fax:
Mailing address:
  • Phone: 330-509-3758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0034664
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.0034664
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.502093
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: