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NPI Code Detail

MEDICARE: KATHERINE MATUSHEK APRN

MEDICARE: KATHERINE MATUSHEK APRN
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
1363LP0200XPediatric Nurse Practitioner12654079-4405UT

General Provider Information

NPI Number : 1336916782
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE MATUSHEK APRN
Provider Business Mailing Address
First Line : 12425 ROSS CREEK DR
Second Line :
City : KAMAS
State : UT
Zip : 84036-9323
Country : US
Telephone Number : 224-388-0720
Fax Number :
Provider Business Practice Location Address
First Line : 345 E GATEWAY DR STE 150
Second Line :
City : HEBER CITY
State : UT
Zip : 84032-4625
Country : US
Telephone Number : 435-657-0101
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2023
Last Update Date : 12/19/2023

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