Healthcare Provider Details

I. General information

NPI: 1205312931
Provider Name (Legal Business Name): JENNIFER A MATVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 08/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201
US

IV. Provider business mailing address

2509 MICHELS LN
BALTIMORE MD
21234-4917
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-5382
  • Fax:
Mailing address:
  • Phone: 410-599-2176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR130363
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR130363
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: