MEDICARE: MARIE MATHURIN 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	163WH0200X	Home Health Registered Nurse	RN9379746	FL

General Provider Information

NPI Number	:	1679979967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE MATHURIN RN

Provider Business Mailing Address
First Line	:	4910 DYER BLVD
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33407-1009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4910 DYER BLVD
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33407-1009
Country	:	US
Telephone Number	:	561-840-6566
Fax Number	:

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

Provider Enumeration Date	:	11/13/2014
Last Update Date	:	11/13/2014

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