MEDICARE: DEBORAH L MATOSKY CNP

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
1	363L00000X	Nurse Practitioner	NP01598	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000638084	OTHER	OH	BCBS-OH
2	421534506159	OTHER	OH	CARESOURCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811936388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH L MATOSKY CNP

Provider Business Mailing Address
First Line	:	2337 SUGAR RIDGE LN
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-2862
Country	:	US
Telephone Number	:	937-297-8999
Fax Number	:	937-233-1965

Provider Business Practice Location Address
First Line	:	2912 SPRINGBORO W
Second Line	:	SUITE 201
City	:	MORAINE
State	:	OH
Zip	:	45439-1674
Country	:	US
Telephone Number	:	937-297-8999
Fax Number	:	937-233-1965

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	09/09/2020

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