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NPI Code Detail

MEDICARE: ANN M MATHEW FNP

MEDICARE: ANN M MATHEW 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
1163W00000XRegistered NurseRN634739PA
2363LF0000XFamily Nurse PractitionerSP021470PA

General Provider Information

NPI Number : 1942644836
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANN M MATHEW FNP
Provider Business Mailing Address
First Line : 9585 WALLEY AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19115-3009
Country : US
Telephone Number : 267-752-0038
Fax Number :
Provider Business Practice Location Address
First Line : 905 TOWER RD # 3188
Second Line :
City : BRISTOL
State : PA
Zip : 19007-3116
Country : US
Telephone Number : 215-785-3201
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2013
Last Update Date : 02/25/2020

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