Healthcare Provider Details

I. General information

NPI: 1942644836
Provider Name (Legal Business Name): ANN M MATHEW FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 TOWER RD # 3188
BRISTOL PA
19007-3116
US

IV. Provider business mailing address

9585 WALLEY AVE
PHILADELPHIA PA
19115-3009
US

V. Phone/Fax

Practice location:
  • Phone: 215-785-3201
  • Fax:
Mailing address:
  • Phone: 267-752-0038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN634739
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP021470
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: