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NPI Code Detail

MEDICARE: MS. DESIREE MATTHEWS

MEDICARE: MS. DESIREE MATTHEWS
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 Nurse266476NC
2363LP0808XPsychiatric/Mental Health Nurse Practitioner5008770NC

General Provider Information

NPI Number : 1356700561
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DESIREE MATTHEWS
Provider Business Mailing Address
First Line : 5700 EXECUTIVE CENTER DR
Second Line : SUITE 110
City : CHARLOTTE
State : NC
Zip : 28212-8858
Country : US
Telephone Number : 704-525-3255
Fax Number :
Provider Business Practice Location Address
First Line : 5700 EXECUTIVE CENTER DR
Second Line : SUITE 110
City : CHARLOTTE
State : NC
Zip : 28212-8858
Country : US
Telephone Number : 704-525-3255
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2016
Last Update Date : 12/08/2016

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