Provider Demographics
NPI:1659952570
Name:SMITH, MATTHEW MADISON (APRN CNP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MADISON
Last Name:SMITH
Suffix:
Gender:M
Credentials:APRN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 W LORAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44074-1087
Mailing Address - Country:US
Mailing Address - Phone:440-775-1881
Mailing Address - Fax:440-744-5707
Practice Address - Street 1:224 W LORAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1087
Practice Address - Country:US
Practice Address - Phone:440-775-1881
Practice Address - Fax:440-744-5707
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028715363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner