Provider Demographics
NPI:1306195102
Name:MAY, MATTHEW J (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:MAY
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:291 N FIREWEED ST
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7540
Mailing Address - Country:US
Mailing Address - Phone:907-262-6454
Mailing Address - Fax:907-262-0832
Practice Address - Street 1:240 HOSPITAL PL STE 103
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7559
Practice Address - Country:US
Practice Address - Phone:907-260-5455
Practice Address - Fax:907-714-3111
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK167884363LF0000X
AK33069163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant