MEDICARE: DR. GERALDINE OKA MATSUMURA PHD APRN

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
1	163W00000X	Registered Nurse	1890474405	UT
2	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	1890478900	UT

General Provider Information

NPI Number	:	1346341971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALDINE OKA MATSUMURA PHD APRN

Provider Business Mailing Address
First Line	:	PO BOX 1036
Second Line	:	117 WEST 200 SOUTH
City	:	FARMINGTON
State	:	UT
Zip	:	84025-1036
Country	:	US
Telephone Number	:	801-451-4843
Fax Number	:	801-451-2839

Provider Business Practice Location Address
First Line	:	117 WEST 200 SOUTH
Second Line	:
City	:	FARMINGTON
State	:	UT
Zip	:	84025-1036
Country	:	US
Telephone Number	:	801-451-4843
Fax Number	:	801-451-2839

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	09/11/2025

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