Provider Demographics
NPI:1578237673
Name:MATOSSIAN, ROBERT PRESTON (RN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:PRESTON
Last Name:MATOSSIAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2177
Mailing Address - Country:US
Mailing Address - Phone:707-972-2736
Mailing Address - Fax:
Practice Address - Street 1:806 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2177
Practice Address - Country:US
Practice Address - Phone:707-972-2736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61183035163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse