Provider Demographics
NPI:1689151680
Name:ELLER, MATTHEW KEITH (CNP)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:KEITH
Last Name:ELLER
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3570 HENRY ST STE 120
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4576
Mailing Address - Country:US
Mailing Address - Phone:231-672-7000
Mailing Address - Fax:231-728-5041
Practice Address - Street 1:3570 HENRY ST STE 120
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-4576
Practice Address - Country:US
Practice Address - Phone:231-672-7000
Practice Address - Fax:231-728-5041
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704370943363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily