Basic Information
| Provider Information | |||||||||
| NPI: | 1316189764 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ONYEKELU | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | NWABUEZE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 MEDICAL VILLAGE DRIVE | ||||||||
| Address2: | #258 | ||||||||
| City: | EDGEWOOD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410175411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593417246 | ||||||||
| FaxNumber: | 8593417867 | ||||||||
| Practice Location | |||||||||
| Address1: | 3131 QUEEN CITY AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452382316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593417246 | ||||||||
| FaxNumber: | 8593417867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2009 | ||||||||
| LastUpdateDate: | 10/27/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | COA.10660-NA | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 080845 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 163W00000X | 313328 | OH | N | Nursing Service Providers | Registered Nurse | 163W00000X | 1103267 | KY | N | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 7100070800 | 05 | KY | MEDICAID | 000000609551 | 01 | ANTHEM | OTHER | 2979746 | 05 | OH | MEDICAID | 300067305 1063493948 | 01 | HEALTHNET | OTHER | 200946590 | 05 | IN | MEDICAID |