Provider Demographics
NPI:1497536858
Name:MATTHEWS, MICHELE LEANNE (CSFA)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:LEANNE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 CEDAR LN SE APT B
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-5026
Mailing Address - Country:US
Mailing Address - Phone:575-914-8484
Mailing Address - Fax:
Practice Address - Street 1:201 CEDAR ST SE STE 7650
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4911
Practice Address - Country:US
Practice Address - Phone:505-357-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM100264734246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant