Provider Demographics
NPI:1073162236
Name:FILICETTI, MATTHEW GARRETT
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GARRETT
Last Name:FILICETTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23557 N HIGH DUNES DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-7917
Mailing Address - Country:US
Mailing Address - Phone:317-770-3716
Mailing Address - Fax:
Practice Address - Street 1:23557 N HIGH DUNES DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-7917
Practice Address - Country:US
Practice Address - Phone:317-770-3716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN206602163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health