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General NPI Number Information
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NPI Number | 1972713618
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Entity Type | Individual
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Provider Name | GRACE ELAINE MATTHEWS RN, CRNP
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 201 PINE BLUFF RD STE 2521801
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City | SALISBURY
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State | MD
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Zip | 21801-7163
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Country | US
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Telephone | 215-432-1884
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Fax |
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Provider Business Mailing Address
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Address Line | 1003 MISTY MOUNTAIN RD # 3504
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City | LYNCHBURG
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State | VA
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Zip | 24502-4049
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Country | US
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Telephone | 215-432-1884
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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 | SP002008C
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 0024168260
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License Number State | VA
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