MEDICARE: LATOYA RENEE MATTHEWS APRN, 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
1	363LF0000X	Family Nurse Practitioner	95014209	CA
2	363LF0000X	Family Nurse Practitioner	829693	NV

General Provider Information

NPI Number	:	1649806050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOYA RENEE MATTHEWS APRN, FNP

Provider Business Mailing Address
First Line	:	4179 S RIVERBOAT RD STE 220
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84123-2986
Country	:	US
Telephone Number	:	801-921-6816
Fax Number	:

Provider Business Practice Location Address
First Line	:	7201 W LAKE MEAD BLVD STE 112
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-8362
Country	:	US
Telephone Number	:	702-703-5160
Fax Number	:	702-946-5052

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

Provider Enumeration Date	:	03/17/2020
Last Update Date	:	01/06/2023

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