Provider Demographics
NPI:1043402498
Name:MATTHEWS, LAURIE I
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:MATTHEWS
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-3543
Mailing Address - Country:US
Mailing Address - Phone:602-243-1773
Mailing Address - Fax:602-276-1984
Practice Address - Street 1:2132 W HASAN DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-5310
Practice Address - Country:US
Practice Address - Phone:602-305-9180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant