Provider Demographics
NPI:1629370556
Name:MATHEWS, MARYANNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARYANNE
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 SPARKLEBERRY BLVD S
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-8868
Mailing Address - Country:US
Mailing Address - Phone:850-556-2303
Mailing Address - Fax:850-627-1992
Practice Address - Street 1:182 SPARKLEBERRY BLVD S
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-8868
Practice Address - Country:US
Practice Address - Phone:850-556-2303
Practice Address - Fax:850-627-1992
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5146675164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse