Provider Demographics
NPI:1043659386
Name:MATIS, CLARE LOUISE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:LOUISE
Last Name:MATIS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 E MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7150
Mailing Address - Country:US
Mailing Address - Phone:302-369-2751
Mailing Address - Fax:
Practice Address - Street 1:324 E MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7150
Practice Address - Country:US
Practice Address - Phone:302-369-2751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG000651363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily