=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326121898
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW J ARMSTRONG APNP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2006
-----------------------------------------------------
Last Update Date | 07/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2575 E EVERGREEN DRIVE PEDIATRIC UROLOGY
-----------------------------------------------------
City | APPLETON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54913-8904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-969-5353
-----------------------------------------------------
Fax | 414-337-7201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2575 E EVERGREEN DRIVE PEDIATRIC UROLOGY
-----------------------------------------------------
City | APPLETON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54913-8904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-969-5353
-----------------------------------------------------
Fax | 414-337-7201
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 2420-083
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------