Provider Demographics
NPI:1093276750
Name:MATWIEJCZUK, MAJA (FNP APRN)
Entity Type:Individual
Prefix:
First Name:MAJA
Middle Name:
Last Name:MATWIEJCZUK
Suffix:
Gender:F
Credentials:FNP APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 ELM STREET
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082
Mailing Address - Country:US
Mailing Address - Phone:860-741-2225
Mailing Address - Fax:860-741-2229
Practice Address - Street 1:113 ELM STREET
Practice Address - Street 2:SUITE 304
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082
Practice Address - Country:US
Practice Address - Phone:860-741-2225
Practice Address - Fax:860-741-2229
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8143363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner