Provider Demographics
NPI:1750857934
Name:MATEJOVSKY, JOAN ADELE (NP-C)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:ADELE
Last Name:MATEJOVSKY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MI
Mailing Address - Zip Code:49274-9575
Mailing Address - Country:US
Mailing Address - Phone:517-252-1299
Mailing Address - Fax:
Practice Address - Street 1:892 E CHICAGO ST STE C
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2063
Practice Address - Country:US
Practice Address - Phone:517-278-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704175538363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily