Healthcare Provider Details

I. General information

NPI: 1780849380
Provider Name (Legal Business Name): MARIANNE MATZO PHD, GNP-BC, FAAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NE 10TH ST
OKLAHOMA CITY OK
73104-5418
US

IV. Provider business mailing address

1122 NE 13TH ST
OKLAHOMA CITY OK
73117-1039
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4385
  • Fax: 405-271-7228
Mailing address:
  • Phone: 405-271-4385
  • Fax: 405-271-7228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberR0082425
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number82425
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: