Provider Demographics
NPI:1407059736
Name:PRICKETT, MATRGIE ELOISE
Entity Type:Individual
Prefix:MRS
First Name:MATRGIE
Middle Name:ELOISE
Last Name:PRICKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 N KINGS RD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-3652
Mailing Address - Country:US
Mailing Address - Phone:208-466-1401
Mailing Address - Fax:208-466-1401
Practice Address - Street 1:47 N KINGS RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-3652
Practice Address - Country:US
Practice Address - Phone:208-466-1401
Practice Address - Fax:208-466-1401
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health