Provider Demographics
NPI:1255736179
Name:OLATUNDE, MATHEW (PMHNP)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:
Last Name:OLATUNDE
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 WENDELL AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-3162
Mailing Address - Country:US
Mailing Address - Phone:419-516-2791
Mailing Address - Fax:
Practice Address - Street 1:17872 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MIDDLE POINT
Practice Address - State:OH
Practice Address - Zip Code:45863
Practice Address - Country:US
Practice Address - Phone:419-968-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH156796164W00000X
OHAPRN.CNP.0033573363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse