Healthcare Provider Details

I. General information

NPI: 1720559073
Provider Name (Legal Business Name): CHRISTINA PETRA MATIAS APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 WEST BLVD
RACINE WI
53405-2146
US

IV. Provider business mailing address

413 WEST BLVD
RACINE WI
53405-2146
US

V. Phone/Fax

Practice location:
  • Phone: 847-401-8609
  • Fax:
Mailing address:
  • Phone: 847-401-8609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number222847
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number19079-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: