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NPI Code Detail

MEDICARE: VICTORIA PRINCESS MATTHEWS FNP

MEDICARE: VICTORIA PRINCESS MATTHEWS FNP
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
1163W00000XRegistered Nurse041.381119IL
2363LF0000XFamily Nurse Practitioner209.017759IL
3363L00000XNurse Practitioner209017759IL

General Provider Information

NPI Number : 1275002701
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTORIA PRINCESS MATTHEWS FNP
Provider Business Mailing Address
First Line : 12040 RAYMOND CT
Second Line :
City : HUNTLEY
State : IL
Zip : 60142-8069
Country : US
Telephone Number : 847-515-1505
Fax Number : 847-515-1503
Provider Business Practice Location Address
First Line : 176 W MOUND RD
Second Line :
City : DECATUR
State : IL
Zip : 62526-1964
Country : US
Telephone Number : 217-875-0163
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2018
Last Update Date : 09/17/2025

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Directions to “ VICTORIA PRINCESS MATTHEWS FNP” Practice Location

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