Provider Demographics
NPI:1962740720
Name:MATHEWS, KRISTIN MICHELE (RN)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MICHELE
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:MICHELE
Other - Last Name:BARONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3482 PETRE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-7901
Mailing Address - Country:US
Mailing Address - Phone:937-605-1690
Mailing Address - Fax:
Practice Address - Street 1:3482 PETRE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-7901
Practice Address - Country:US
Practice Address - Phone:937-605-1690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.350873163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse