Provider Demographics
NPI:1477266047
Name:MATTHEWS, CRAIG (RN)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 80 BOX 11207
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96367-0015
Mailing Address - Country:US
Mailing Address - Phone:671-632-2850
Mailing Address - Fax:
Practice Address - Street 1:124 S CHALAN HENRY J KAISER
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-5646
Practice Address - Country:US
Practice Address - Phone:671-632-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GURX0749163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse