Provider Demographics
NPI:1942811377
Name:MATHEWS, THANHAN (NP)
Entity Type:Individual
Prefix:
First Name:THANHAN
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E ST
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-2617
Mailing Address - Country:US
Mailing Address - Phone:559-386-4500
Mailing Address - Fax:
Practice Address - Street 1:148 E KINGS ST
Practice Address - Street 2:
Practice Address - City:AVENAL
Practice Address - State:CA
Practice Address - Zip Code:93204-1529
Practice Address - Country:US
Practice Address - Phone:559-386-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA835965363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care