Provider Demographics
NPI:1477019511
Name:MATTHYS, NICOLE NOELLE (ARNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:NOELLE
Last Name:MATTHYS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:NOELLE
Other - Last Name:STIVARIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3009 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-1137
Mailing Address - Country:US
Mailing Address - Phone:563-320-6241
Mailing Address - Fax:
Practice Address - Street 1:3009 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-1137
Practice Address - Country:US
Practice Address - Phone:563-320-6241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA114998363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily