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General NPI Number Information
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NPI Number | 1861008716
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Entity Type | Individual
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Provider Name | MATTHEW M. HESSE AGPCNP
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Gender | Male
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 202 62ND AVE NE
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City | TACOMA
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State | WA
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Zip | 98422-4018
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Country | US
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Telephone | 319-231-0857
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Fax |
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Provider Business Mailing Address
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Address Line | 202 62ND AVE NE
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City | TACOMA
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State | WA
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Zip | 98422-4018
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Country | US
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Telephone | 319-231-0857
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | ARNP.AP.61106880-NP
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License Number State | WA
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