MEDICARE: RUTH MICHELLE MATKIN DOM, RN

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	163WG0000X	General Practice Registered Nurse	R49349	NM
2	171100000X	Acupuncturist	1050	NM

General Provider Information

NPI Number	:	1134423874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH MICHELLE MATKIN DOM, RN

Provider Business Mailing Address
First Line	:	7120 4TH ST NW
Second Line	:
City	:	LOS RANCHOS
State	:	NM
Zip	:	87107-6642
Country	:	US
Telephone Number	:	505-899-7095
Fax Number	:

Provider Business Practice Location Address
First Line	:	7120 4TH ST NW
Second Line	:
City	:	LOS RANCHOS
State	:	NM
Zip	:	87107-6642
Country	:	US
Telephone Number	:	505-899-7095
Fax Number	:

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

Provider Enumeration Date	:	01/10/2011
Last Update Date	:	01/10/2011

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