Provider Demographics
NPI:1346341971
Name:MATSUMURA, GERALDINE OKA (PHD APRN)
Entity Type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:OKA
Last Name:MATSUMURA
Suffix:
Gender:F
Credentials:PHD APRN
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 1036
Mailing Address - Street 2:117 WEST 200 SOUTH
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-1036
Mailing Address - Country:US
Mailing Address - Phone:801-451-4843
Mailing Address - Fax:801-451-2839
Practice Address - Street 1:117 WEST 200 SOUTH
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-1036
Practice Address - Country:US
Practice Address - Phone:801-451-4843
Practice Address - Fax:801-451-2839
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1890474405163W00000X
UT1890478900163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)