Provider Demographics
NPI:1417423013
Name:PICKENPAUGH, MATTHEW MICHAEL (RN, HO)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:MICHAEL
Last Name:PICKENPAUGH
Suffix:
Gender:M
Credentials:RN, HO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42700 KEITHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43724-9583
Mailing Address - Country:US
Mailing Address - Phone:740-581-0223
Mailing Address - Fax:
Practice Address - Street 1:42700 KEITHTOWN RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-9583
Practice Address - Country:US
Practice Address - Phone:740-581-0223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.366264163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse