Provider Demographics
NPI:1962478982
Name:MATHIAS, NANCY G (CNM)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:G
Last Name:MATHIAS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 RUNNYMEADE DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-0801
Mailing Address - Country:US
Mailing Address - Phone:803-980-0090
Mailing Address - Fax:
Practice Address - Street 1:DEPT OF OB GYN MIDWIFERY DIVISION
Practice Address - Street 2:4011 OLD CLINIC BLDG CB#7570
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7570
Practice Address - Country:US
Practice Address - Phone:919-843-2490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6895367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000057Medicaid