MEDICARE: MS. TASHELL MATESE RAY REGISTERED NURSE

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	163W00000X	Registered Nurse	RN486683	OH

General Provider Information

NPI Number	:	1861956674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TASHELL MATESE RAY REGISTERED NURSE

Provider Business Mailing Address
First Line	:	3721 W 13TH ST # UP
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-2806
Country	:	US
Telephone Number	:	216-678-7120
Fax Number	:

Provider Business Practice Location Address
First Line	:	3721 W 13TH ST # UP
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-2806
Country	:	US
Telephone Number	:	216-678-7120
Fax Number	:

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

Provider Enumeration Date	:	01/25/2019
Last Update Date	:	01/10/2023

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