Healthcare Provider Details

I. General information

NPI: 1073803573
Provider Name (Legal Business Name): JOAN M MATEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4482 HURON ST
NORTH BRANCH MI
48461-8667
US

IV. Provider business mailing address

401 S BALLENGER HWY
FLINT MI
48532-3638
US

V. Phone/Fax

Practice location:
  • Phone: 810-688-3093
  • Fax:
Mailing address:
  • Phone: 810-342-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704128073
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: