Provider Demographics
NPI:1013437771
Name:MATOS, WILMA (HOME CARE ATTENDANT)
Entity Type:Individual
Prefix:
First Name:WILMA
Middle Name:
Last Name:MATOS
Suffix:
Gender:F
Credentials:HOME CARE ATTENDANT
Other - Prefix:
Other - First Name:WILMA
Other - Middle Name:MELITZA
Other - Last Name:MATOS FERRER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1210 AGATE TRL
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3920
Mailing Address - Country:US
Mailing Address - Phone:478-997-2005
Mailing Address - Fax:
Practice Address - Street 1:1210 AGATE TRL
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-3920
Practice Address - Country:US
Practice Address - Phone:478-997-2005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide