Provider Demographics
NPI:1811936388
Name:MATOSKY, DEBORAH L (CNP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:MATOSKY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:L
Other - Last Name:STEMPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2337 SUGAR RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-2862
Mailing Address - Country:US
Mailing Address - Phone:937-297-8999
Mailing Address - Fax:937-233-1965
Practice Address - Street 1:2912 SPRINGBORO W
Practice Address - Street 2:SUITE 201
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1674
Practice Address - Country:US
Practice Address - Phone:937-297-8999
Practice Address - Fax:937-233-1965
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP01598363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000638084OtherBCBS-OH
OH421534506159OtherCARESOURCE
OH2050435Medicaid
OHNP05463Medicare PIN
OH2050435Medicaid