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NPI Code Detail

MEDICARE: MRS. MARIAN ANN MATTERN CNP, PMHNP, RN

MEDICARE: MRS. MARIAN ANN MATTERN CNP, PMHNP, RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN.330047OH
2163W00000XRegistered NurseRN757290PA
32084P0802XAddiction Psychiatry PhysicianCOA13427NPOH
4363L00000XNurse PractitionerCOA.13427.NPOH
5363LA2200XAdult Health Nurse PractitionerAPRN.CNP.13427OH
6363LA2200XAdult Health Nurse PractitionerSP026529PA
7363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN.CNP.13427OH
8363LP0808XPsychiatric/Mental Health Nurse PractitionerSP026528PA
9363L00000XNurse PractitionerAPRN.CNP.13427OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
212428078OTHEROHCAQH

General Provider Information

NPI Number : 1366799082
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARIAN ANN MATTERN CNP, PMHNP, RN
Provider Business Mailing Address
First Line : 527 N MERIDIAN RD
Second Line :
City : YOUNGSTOWN
State : OH
Zip : 44509-1227
Country : US
Telephone Number : 330-797-0070
Fax Number : 330-797-9146
Provider Business Practice Location Address
First Line : 550 W CHALMERS AVE
Second Line :
City : YOUNGSTOWN
State : OH
Zip : 44511-1576
Country : US
Telephone Number : 330-797-0070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2012
Last Update Date : 01/09/2023

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