Provider Demographics
NPI:1265713135
Name:MOROVIA, MATTU (RN,BSN)
Entity type:Individual
Prefix:
First Name:MATTU
Middle Name:
Last Name:MOROVIA
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 RENE CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4939
Mailing Address - Country:US
Mailing Address - Phone:614-668-8170
Mailing Address - Fax:
Practice Address - Street 1:522 RENE CT
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-4939
Practice Address - Country:US
Practice Address - Phone:614-668-8170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH371249163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse