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General NPI Number Information
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NPI Number | 1568729770
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Entity Type | Individual
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Provider Name | ASHLEY M MATCHACK LPN
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Gender | Female
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Dates
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Enumeration Date | 04/12/2012
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 423 GRAND CIRCUIT BLVD
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City | DELAWARE
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State | OH
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Zip | 43015-3327
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Country | US
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Telephone | 419-516-9871
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Fax |
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Provider Business Mailing Address
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Address Line | 6008 PARIS BLVD N
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City | WESTERVILLE
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State | OH
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Zip | 43081-4161
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Country | US
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Telephone | 419-516-9871
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN.147181-M-IV
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License Number State | OH
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