Provider Demographics
NPI:1174831713
Name:MATTHEWS, MARSHA CROUCH (GNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:CROUCH
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:GNP-BC
Other - Prefix:MS
Other - First Name:MARSHA
Other - Middle Name:CROUCH
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:GNP-BC
Mailing Address - Street 1:212 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-3317
Mailing Address - Country:US
Mailing Address - Phone:432-758-4745
Mailing Address - Fax:432-758-4747
Practice Address - Street 1:212 NW 10TH ST
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3317
Practice Address - Country:US
Practice Address - Phone:432-758-4745
Practice Address - Fax:432-758-4747
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX707999363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology