Provider Demographics
NPI:1942623996
Name:MATTHEWS, MAUREEN (RN, IBLLC)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:RN, IBLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:ATTN: CVMC FINANCE DEPT.
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-371-4415
Mailing Address - Fax:802-371-5347
Practice Address - Street 1:130 FISCHER RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602
Practice Address - Country:US
Practice Address - Phone:802-371-4415
Practice Address - Fax:802-371-5347
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0023433163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant