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General NPI Number Information
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NPI Number | 1205196458
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Entity Type | Individual
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Provider Name | EMILY SUZANNE MATHEW NP,RN, APN
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Gender | Female
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Dates
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Enumeration Date | 05/22/2012
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 5950 METRO WAY SW
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City | WYOMING
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State | MI
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Zip | 49519-9514
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Country | US
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Telephone | 616-252-8100
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Fax | 616-252-8181
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Provider Business Mailing Address
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Address Line | 5900 BYRON CENTER AVE SW MEDICAL ADMINISTRATION
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City | WYOMING
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State | MI
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Zip | 49519-9606
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Country | US
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Telephone | 616-252-3243
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Fax | 616-252-0260
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 745774
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP122357
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704240951
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License Number State | MI
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