=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164305553
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW BASKWELL RN, MSN, ACCNS-AG
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2025
-----------------------------------------------------
Last Update Date | 07/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 676 FUTENMA, GINOWAN OKINAWA 901-2202
-----------------------------------------------------
City | FPO
-----------------------------------------------------
State | AP
-----------------------------------------------------
Zip | 96379-0003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 819-971-9335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1834 FAIRVIEW AVE
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18042-3973
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-723-3779
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Clinical Nurse Specialist
-----------------------------------------------------
License Number | 95308083
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------