Provider Demographics
NPI:1285661694
Name:BUYNO, MATTHEW JEROME (LPN)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JEROME
Last Name:BUYNO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 HUNTERS RUN
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4379
Mailing Address - Country:US
Mailing Address - Phone:614-260-7987
Mailing Address - Fax:
Practice Address - Street 1:735 HUNTERS RUN
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-4379
Practice Address - Country:US
Practice Address - Phone:614-260-7987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.125246164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2425389Medicaid
OH2710114Medicaid