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NPI Code Detail

MEDICARE: MS. ANDRA DELORIS MATTHEWS RN

MEDICARE: MS. ANDRA DELORIS MATTHEWS RN
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
1163WC0400XCase Management Registered NurseRN56556DC

General Provider Information

NPI Number : 1518393214
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANDRA DELORIS MATTHEWS RN
Provider Business Mailing Address
First Line : 12033 AGENCY RD
Second Line :
City : PARKER
State : AZ
Zip : 85344-7718
Country : US
Telephone Number : 928-669-2137
Fax Number : 928-669-3388
Provider Business Practice Location Address
First Line : 12033 AGENCY RD
Second Line :
City : PARKER
State : AZ
Zip : 85344-7718
Country : US
Telephone Number : 928-669-2137
Fax Number : 928-669-3388
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2013
Last Update Date : 09/25/2013

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