Provider Demographics
NPI:1972713618
Name:MATTHEWS, GRACE ELAINE (RN, CRNP)
Entity Type:Individual
Prefix:MISS
First Name:GRACE
Middle Name:ELAINE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:RN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 MISTY MOUNTAIN RD # 3504
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4049
Mailing Address - Country:US
Mailing Address - Phone:215-432-1884
Mailing Address - Fax:
Practice Address - Street 1:201 PINE BLUFF RD STE 2521801
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7163
Practice Address - Country:US
Practice Address - Phone:215-432-1884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP002008C363LA2200X
VA0024168260363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health