Provider Demographics
NPI:1356385496
Name:MATTHEWS, ELIZABETH (NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MATTHEWS
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 1:403 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-3847
Mailing Address - Country:US
Mailing Address - Phone:406-388-8708
Mailing Address - Fax:406-388-8710
Practice Address - Street 1:403 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-3847
Practice Address - Country:US
Practice Address - Phone:406-388-8708
Practice Address - Fax:406-388-8710
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR814478363L00000X
MTNUR-RN-LIC-74827363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122887Medicaid
MS202011213AOtherBLUE CROSS
MSP00227076OtherRAILROAD MEDICARE
MS500001757Medicare ID - Type Unspecified
MSS54696Medicare UPIN