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NPI Code Detail

MEDICARE: MATTHEW HUELSMANN FNP

MEDICARE: MATTHEW HUELSMANN FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program041462133IL
2363LF0000XFamily Nurse Practitioner209025525IL

General Provider Information

NPI Number : 1174113476
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW HUELSMANN FNP
Provider Business Mailing Address
First Line : 1 HAIRPIN DR
Second Line :
City : EDWARDSVILLE
State : IL
Zip : 62026-0001
Country : US
Telephone Number : 618-650-5555
Fax Number :
Provider Business Practice Location Address
First Line : 16 EXECUTIVE DR STE 100
Second Line :
City : FAIRVIEW HEIGHTS
State : IL
Zip : 62208-1366
Country : US
Telephone Number : 618-622-9073
Fax Number : 618-622-9230
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2021
Last Update Date : 03/22/2023

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