Provider Demographics
NPI:1619683224
Name:LAIRD, MATTHEW (APRN-NP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:LAIRD
Suffix:
Gender:M
Credentials:APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 E VAN BUREN ST UNIT 68025
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082-8957
Mailing Address - Country:US
Mailing Address - Phone:480-618-7023
Mailing Address - Fax:480-781-4866
Practice Address - Street 1:4949 E VAN BUREN ST UNIT 68025
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85082-8957
Practice Address - Country:US
Practice Address - Phone:480-618-7023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ291728363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty