Healthcare Provider Details

I. General information

NPI: 1164305553
Provider Name (Legal Business Name): MATTHEW BASKWELL RN, MSN, ACCNS-AG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 07/31/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 FUTENMA, GINOWAN OKINAWA 901-2202
FPO AP
96379-0003
US

IV. Provider business mailing address

1834 FAIRVIEW AVE
EASTON PA
18042-3973
US

V. Phone/Fax

Practice location:
  • Phone: 819-971-9335
  • Fax:
Mailing address:
  • Phone: 315-723-3779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number95308083
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: