Provider Demographics
NPI:1235108762
Name:MATTHEWS, MELINDA W (ANP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:W
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 HEART DR
Practice Address - Street 2:EAST CAROLINA HEART INSTITUTE AT ECU
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8944
Practice Address - Country:US
Practice Address - Phone:252-744-4400
Practice Address - Fax:252-744-3987
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900226363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
561638624OtherCOMMERCIAL PAYERS
B8669OtherMEDCOST
NC7004109Medicaid
NCP36093Medicare UPIN
NC7004109Medicaid
NC2802561AMedicare PIN