Provider Demographics
NPI:1245832666
Name:MATIAS, DANIELLE MARIE (APN-BC, WHNP)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:MARIE
Last Name:MATIAS
Suffix:
Gender:F
Credentials:APN-BC, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1828 W LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4663
Mailing Address - Country:US
Mailing Address - Phone:732-869-5700
Mailing Address - Fax:
Practice Address - Street 1:1828 W LAKE AVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE CITY
Practice Address - State:NJ
Practice Address - Zip Code:07753-4663
Practice Address - Country:US
Practice Address - Phone:732-869-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01076400363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ01076400OtherAPN