MEDICARE: SHARLYN MATTHEWS LPN

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	164W00000X	Licensed Practical Nurse	4703031247	MI

General Provider Information

NPI Number	:	1679017396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARLYN MATTHEWS LPN

Provider Business Mailing Address
First Line	:	204 W. STATE STREET
Second Line	:	PO BOX 3038
City	:	MONTROSE
State	:	MI
Zip	:	48867
Country	:	US
Telephone Number	:	810-639-5411
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 W. STATE STREET
Second Line	:
City	:	MONTROSE
State	:	MI
Zip	:	48457-9004
Country	:	US
Telephone Number	:	810-639-5411
Fax Number	:

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

Provider Enumeration Date	:	12/14/2016
Last Update Date	:	12/14/2016

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