Healthcare Provider Details

I. General information

NPI: 1811636053
Provider Name (Legal Business Name): MARLEEN MATSKO RN-BC, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 PHOENIX AVE
BELLEFONTE PA
16823-1309
US

IV. Provider business mailing address

374 PHOENIX AVE
BELLEFONTE PA
16823-1309
US

V. Phone/Fax

Practice location:
  • Phone: 814-810-2389
  • Fax: 814-810-2390
Mailing address:
  • Phone: 814-810-2389
  • Fax: 814-810-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN532457
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN532457
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: