Provider Demographics
NPI:1679205322
Name:HYLAND, MATTIE HELEN
Entity Type:Individual
Prefix:MRS
First Name:MATTIE
Middle Name:HELEN
Last Name:HYLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MATTIE
Other - Middle Name:HELEN
Other - Last Name:DUNLAP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:495 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3176
Mailing Address - Country:US
Mailing Address - Phone:901-288-3254
Mailing Address - Fax:
Practice Address - Street 1:106 STARRET ST STE 100
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3993
Practice Address - Country:US
Practice Address - Phone:740-687-0042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program