Provider Demographics
NPI:1518279033
Name:MATKIN, GINGER LEIGH (CST)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:LEIGH
Last Name:MATKIN
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 E JASMINE CT
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-7526
Mailing Address - Country:US
Mailing Address - Phone:208-899-6882
Mailing Address - Fax:
Practice Address - Street 1:4112 E JASMINE CT
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-7526
Practice Address - Country:US
Practice Address - Phone:208-899-6882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID112100246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist