Provider Demographics
NPI:1508976341
Name:HALVERSON, MATTHEW DAVID (NP)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DAVID
Last Name:HALVERSON
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:35 STOCKHOLM AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01966-1254
Mailing Address - Country:US
Mailing Address - Phone:978-994-6383
Mailing Address - Fax:978-309-8472
Practice Address - Street 1:292 WASHINGTON ST
Practice Address - Street 2:SEACOAST NURSING AND REHABILITATION CENTER
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-4832
Practice Address - Country:US
Practice Address - Phone:978-716-3600
Practice Address - Fax:978-716-3669
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-06-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA250337363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP4049Medicare ID - Type Unspecified