Provider Demographics
NPI:1497095210
Name:ANDERSON, MATTHEW J (FNP)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9352
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-9352
Mailing Address - Country:US
Mailing Address - Phone:406-203-4776
Mailing Address - Fax:406-327-6702
Practice Address - Street 1:2831 FORT MISSOULA RD STE 203
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7479
Practice Address - Country:US
Practice Address - Phone:406-203-6261
Practice Address - Fax:406-327-6702
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT45557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily