Provider Demographics
NPI:1508592783
Name:MATOS, AMIE MARIE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMIE
Middle Name:MARIE
Last Name:MATOS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 TANGLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-2944
Mailing Address - Country:US
Mailing Address - Phone:413-219-6820
Mailing Address - Fax:
Practice Address - Street 1:10 HOSPITAL DR STE 204
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-6603
Practice Address - Country:US
Practice Address - Phone:413-533-3912
Practice Address - Fax:413-533-3299
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2280100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily