Provider Demographics
NPI:1558959932
Name:SOENTGEN, MATTHEW OLIVER (NP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:OLIVER
Last Name:SOENTGEN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 OAKDALE DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-9658
Mailing Address - Country:US
Mailing Address - Phone:941-416-6565
Mailing Address - Fax:
Practice Address - Street 1:6336 US 64
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-7141
Practice Address - Country:US
Practice Address - Phone:828-430-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013926363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner