Provider Demographics
NPI:1982781217
Name:MATUSICKY, ANA
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:
Last Name:MATUSICKY
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 1:223 OLDEN AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-3528
Mailing Address - Country:US
Mailing Address - Phone:330-459-3941
Mailing Address - Fax:
Practice Address - Street 1:223 OLDEN AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-3528
Practice Address - Country:US
Practice Address - Phone:330-459-3941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2415909Medicare ID - Type UnspecifiedAIDE