Provider Demographics
NPI:1992182521
Name:MATUSZEWSKI, GRETCHEN
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:MATUSZEWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 VILLAGE SQUARE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1783
Mailing Address - Country:US
Mailing Address - Phone:419-872-3243
Mailing Address - Fax:419-872-3284
Practice Address - Street 1:1103 VILLAGE SQUARE DR
Practice Address - Street 2:STE 202
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1783
Practice Address - Country:US
Practice Address - Phone:419-872-3243
Practice Address - Fax:419-872-3284
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.327715163W00000X
OHCOA.17454-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0134473Medicaid
OH0134473Medicaid