Provider Demographics
NPI:1518361021
Name:MATHEW, ANN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2566 RADBURN LANE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-5420
Mailing Address - Country:US
Mailing Address - Phone:704-216-8834
Mailing Address - Fax:704-797-0517
Practice Address - Street 1:1811 E INNES ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-6030
Practice Address - Country:US
Practice Address - Phone:704-216-8834
Practice Address - Fax:704-797-0517
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1518361021OtherNPI
NCNCM3227AOtherMEDICARE PTAN