MEDICARE: MS. LAURIE MATTHEWS I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1043402498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURIE MATTHEWS I

Provider Business Mailing Address
First Line	:	1522 E SOUTHERN AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-3543
Country	:	US
Telephone Number	:	602-243-1773
Fax Number	:	602-276-1984

Provider Business Practice Location Address
First Line	:	2132 W HASAN DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-5310
Country	:	US
Telephone Number	:	602-305-9180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2007
Last Update Date	:	08/09/2007

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