MEDICARE: MATT LANSING

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1841035383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATT LANSING

Provider Business Mailing Address
First Line	:	2028 RIVER RUN TRL APT A
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-6084
Country	:	US
Telephone Number	:	541-761-6621
Fax Number	:

Provider Business Practice Location Address
First Line	:	2028 RIVER RUN TRL APT A
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-6084
Country	:	US
Telephone Number	:	541-761-6621
Fax Number	:

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

Provider Enumeration Date	:	06/26/2024
Last Update Date	:	06/26/2024

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Directions to “ MATT LANSING ” Practice Location

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