Provider Demographics
NPI:1538637178
Name:MATHEWS, MARIE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 TELFORD ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-1238
Mailing Address - Country:US
Mailing Address - Phone:607-434-6398
Mailing Address - Fax:
Practice Address - Street 1:14 TELFORD ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-1238
Practice Address - Country:US
Practice Address - Phone:607-434-6398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22373650163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant