Provider Demographics
NPI:1730354754
Name:MATEER, JOHANNA LOUISE
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:LOUISE
Last Name:MATEER
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 1:8864 UNITED LANE APT 4
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-9165
Mailing Address - Country:US
Mailing Address - Phone:330-464-2753
Mailing Address - Fax:
Practice Address - Street 1:8938 FIVE POINTS RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-9165
Practice Address - Country:US
Practice Address - Phone:740-664-2396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2719473374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide