Provider Demographics
NPI:1710557426
Name:SAHAWNEH, MATHEW MUNTHER (RN)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:MUNTHER
Last Name:SAHAWNEH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811C SPANIEL DR
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-3700
Mailing Address - Country:US
Mailing Address - Phone:251-510-9290
Mailing Address - Fax:
Practice Address - Street 1:6811C SPANIEL DR
Practice Address - Street 2:
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-3700
Practice Address - Country:US
Practice Address - Phone:251-510-9290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-26
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-164366163W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163W00000XNursing Service ProvidersRegistered Nurse