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NPI Code Detail

MEDICARE: CAROLINE MATVYA

MEDICARE:   CAROLINE  MATVYA
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
1363LA2200XAdult Health Nurse Practitioner71001142AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073623419
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLINE MATVYA
Provider Business Mailing Address
First Line : PO BOX 15753
Second Line :
City : FORT WAYNE
State : IN
Zip : 46885-5753
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1010 W WASHINGTON CENTER RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-4155
Country : US
Telephone Number : 269-450-3096
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 12/06/2007

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Directions to “ CAROLINE MATVYA ” Practice Location

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