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General NPI Number Information
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NPI Number | 1194022921
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Entity Type | Individual
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Provider Name | SUZANNE RAYE MATTHEWS F.N.P.-B.C.
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Gender | Female
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Dates
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Enumeration Date | 02/14/2011
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 307 BROADWAY
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City | MARBLE HILL
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State | MO
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Zip | 63764
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Country | US
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Telephone | 573-238-0038
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Fax | 573-238-0042
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Provider Business Mailing Address
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Address Line | HC 64 BOX 5010
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City | MARBLE HILL
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State | MO
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Zip | 63764-9413
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Country | US
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Telephone | 573-986-8705
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2010032729
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License Number State | MO
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