Provider Demographics
NPI:1437313459
Name:MATSU, MARIAN ANITA (RN/LSA)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:ANITA
Last Name:MATSU
Suffix:
Gender:F
Credentials:RN/LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3835
Mailing Address - Country:US
Mailing Address - Phone:281-690-4678
Mailing Address - Fax:281-565-8808
Practice Address - Street 1:1201 BROOKS ST
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3835
Practice Address - Country:US
Practice Address - Phone:281-690-4678
Practice Address - Fax:281-565-8808
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX446156163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00217OtherLICENSED SURGICAL ASSISTANT
TX446156OtherREGISTERED NURSE