MEDICARE: MATTHEW WILLIAM HOWARD 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	163WE0003X	Emergency Registered Nurse	185328	CO
2	163WE0003X	Emergency Registered Nurse	774296	CA

General Provider Information

NPI Number	:	1568712859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW WILLIAM HOWARD RN

Provider Business Mailing Address
First Line	:	1313 E SAN MIGUEL ST APT 7
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-3686
Country	:	US
Telephone Number	:	303-945-5084
Fax Number	:

Provider Business Practice Location Address
First Line	:	1313 E SAN MIGUEL ST APT 7
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-3686
Country	:	US
Telephone Number	:	303-945-5084
Fax Number	:

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

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	09/13/2012

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