Provider Demographics
NPI:1679848659
Name:MATHEWS, DOROTHY R (RN)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:R
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W WASHINGTON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-5475
Mailing Address - Country:US
Mailing Address - Phone:715-845-3637
Mailing Address - Fax:715-845-1977
Practice Address - Street 1:209 W WASHINGTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-5475
Practice Address - Country:US
Practice Address - Phone:715-845-3637
Practice Address - Fax:715-845-1977
Is Sole Proprietor?:No
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14029330163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)