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General NPI Number Information
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NPI Number | 1477043735
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Entity Type | Organization
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Legal Business Name | ERICA MATLUCK, NURSE PRACTITIONER IN FAMILY HEATH, PLLC
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Dates
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Enumeration Date | 05/12/2018
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Last Update Date | 06/19/2018
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Provider Practice Location Address
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Address Line | 17 JOHN ST
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City | NEW YORK
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State | NY
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Zip | 10038
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Country | US
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Telephone | 415-849-0651
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Fax | 628-895-9500
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Provider Business Mailing Address
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Address Line | 17 JOHN ST # 603
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City | NEW YORK
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State | NY
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Zip | 10038-4010
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Country | US
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Telephone | 415-849-0651
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Fax | 628-895-9500
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Authorized Official
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Title or Position | PROVIDER
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Name | ERICA RAGAN MATLUCK
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Credential | NP, ND
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Telephone | 415-849-0651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ND480
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | RN668584
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | NP-337922
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License Number State | NY
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