Provider Demographics
NPI:1831338706
Name:MATTORANO, KATHY ELLEN (RN)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:ELLEN
Last Name:MATTORANO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2926 PHILLIPS RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-8770
Mailing Address - Country:US
Mailing Address - Phone:513-932-3185
Mailing Address - Fax:
Practice Address - Street 1:2926 PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-8770
Practice Address - Country:US
Practice Address - Phone:513-932-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 256859163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse