Provider Demographics
NPI:1710190491
Name:MATHEWS, ANNE T (NP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:T
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:T
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2335 BURSON ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8430
Mailing Address - Country:US
Mailing Address - Phone:614-513-1847
Mailing Address - Fax:
Practice Address - Street 1:1585 GEORGESVILLE SQ
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-3777
Practice Address - Country:US
Practice Address - Phone:614-335-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 07632-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCOA 07632-NPOtherLICENSE