Healthcare Provider Details

I. General information

NPI: 1649369604
Provider Name (Legal Business Name): JANICE L MATHEWS ACNP, ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 MEDICAL PKWY STE 500
ANNAPOLIS MD
21401-3268
US

IV. Provider business mailing address

7400 FORESTS EDGE CT
LAUREL MD
20707-9428
US

V. Phone/Fax

Practice location:
  • Phone: 410-573-6480
  • Fax: 410-573-9413
Mailing address:
  • Phone: 682-465-8185
  • Fax: 682-465-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number436302
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number436308
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: