Healthcare Provider Details

I. General information

NPI: 1083904577
Provider Name (Legal Business Name): LAURELL MATTHEWS ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURIE MATTHEWS

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3538 N HIGHWAY 112 SUITE 2
FAYETTEVILLE AR
72704-5485
US

IV. Provider business mailing address

3538 N HIGHWAY 112 SUITE 2
FAYETTEVILLE AR
72704-5485
US

V. Phone/Fax

Practice location:
  • Phone: 479-790-2200
  • Fax:
Mailing address:
  • Phone: 479-790-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number2100026
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: