Healthcare Provider Details

I. General information

NPI: 1679973630
Provider Name (Legal Business Name): MATTHEW ALLAN EIFRID APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1657 HOLLAND RD STE A
MAUMEE OH
43537-1661
US

IV. Provider business mailing address

18660 BAGLEY RD STE 101
MIDDLEBURG HEIGHTS OH
44130-3483
US

V. Phone/Fax

Practice location:
  • Phone: 419-482-1168
  • Fax: 419-574-5687
Mailing address:
  • Phone: 440-973-8400
  • Fax: 440-201-6400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.16027
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.16027
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: