Provider Demographics
NPI:1366030660
Name:MATTHEWS, JOANNA MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:MARIE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4970 RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MI
Mailing Address - Zip Code:48731-5155
Mailing Address - Country:US
Mailing Address - Phone:989-375-2214
Mailing Address - Fax:
Practice Address - Street 1:4970 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MI
Practice Address - Zip Code:48731-5155
Practice Address - Country:US
Practice Address - Phone:989-375-2214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704270254363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner