Provider Demographics
NPI:1164170999
Name:MATTHEWS, DEBBIE
Entity Type:Individual
Prefix:MRS
First Name:DEBBIE
Middle Name:
Last Name:MATTHEWS
Suffix:
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 1:2801 MANHATTAN BLVD # 3169
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2987
Mailing Address - Country:US
Mailing Address - Phone:504-671-7458
Mailing Address - Fax:504-218-7221
Practice Address - Street 1:1013 MANHATTAN BLVD APT 10
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-4645
Practice Address - Country:US
Practice Address - Phone:504-671-7458
Practice Address - Fax:504-218-7221
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA005961619172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver