Healthcare Provider Details

I. General information

NPI: 1649834359
Provider Name (Legal Business Name): MATTHEW DONALD PRESTON AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 N HARRISON ST
SAGINAW MI
48602-4727
US

IV. Provider business mailing address

1101 ADAMS DR
MIDLAND MI
48642-3060
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-4220
  • Fax: 989-583-4287
Mailing address:
  • Phone: 989-513-3853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number4704288053
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: