Provider Demographics
NPI:1609288182
Name:MATZ, NICHOLE RENNE (BS)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:RENNE
Last Name:MATZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:RENNE
Other - Last Name:METTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:272 MEDICAL LOOP
Mailing Address - Street 2:SUITE E
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471
Mailing Address - Country:US
Mailing Address - Phone:541-440-3532
Mailing Address - Fax:541-440-3554
Practice Address - Street 1:621 W MADRONE ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3090
Practice Address - Country:US
Practice Address - Phone:541-672-2691
Practice Address - Fax:541-492-0190
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator