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NPI Code Detail

MEDICARE: DEBORAH MATWETWE FNP

MEDICARE: DEBORAH MATWETWE FNP
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
1363LF0000XFamily Nurse Practitioner4704267410MI

General Provider Information

NPI Number : 1760313555
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH MATWETWE FNP
Provider Business Mailing Address
First Line : 50 INDUSTRIAL PARK RD
Second Line :
City : BANGOR
State : MI
Zip : 49013-1246
Country : US
Telephone Number : 269-302-2008
Fax Number :
Provider Business Practice Location Address
First Line : 800 M 139
Second Line :
City : BENTON HARBOR
State : MI
Zip : 49022-3881
Country : US
Telephone Number : 269-302-2008
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2026
Last Update Date : 05/28/2026

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Directions to “ DEBORAH MATWETWE FNP” Practice Location

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