Provider Demographics
NPI:1578678033
Name:MATTHEWS, CAROL ROSE (APN, CNS)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ROSE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:APN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9485 MENTOR AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4597
Mailing Address - Country:US
Mailing Address - Phone:440-205-5755
Mailing Address - Fax:440-205-5792
Practice Address - Street 1:9485 MENTOR AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4597
Practice Address - Country:US
Practice Address - Phone:440-205-5755
Practice Address - Fax:440-205-5792
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNS-07582364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN141455OtherSTATE BOARD OF NURSING
OH2511419Medicaid
OHNS-07582OtherSTATE BOARD OF NURSING
OHQ15788Medicare UPIN
OH2511419Medicaid
OHNS-07582OtherSTATE BOARD OF NURSING
OHP00748590Medicare PIN