Provider Demographics
NPI:1083904577
Name:MATTHEWS, LAURELL (ND)
Entity Type:Individual
Prefix:
First Name:LAURELL
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3538 N HIGHWAY 112
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-5485
Mailing Address - Country:US
Mailing Address - Phone:479-790-2200
Mailing Address - Fax:
Practice Address - Street 1:3538 N HIGHWAY 112
Practice Address - Street 2:SUITE 2
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5485
Practice Address - Country:US
Practice Address - Phone:479-790-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2100026175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath