Provider Demographics
NPI:1184374175
Name:MATOVINA, CHRISTINE FRANCES (SOLE PROPIETOR)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:FRANCES
Last Name:MATOVINA
Suffix:
Gender:F
Credentials:SOLE PROPIETOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7531 GOLDENROD DR
Mailing Address - Street 2:
Mailing Address - City:MENTOR ON THE LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44060-3307
Mailing Address - Country:US
Mailing Address - Phone:859-893-8669
Mailing Address - Fax:
Practice Address - Street 1:7531 GOLDENROD DR
Practice Address - Street 2:
Practice Address - City:MENTOR ON THE LAKE
Practice Address - State:OH
Practice Address - Zip Code:44060-3307
Practice Address - Country:US
Practice Address - Phone:859-893-8669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-24
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH999999374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide