Provider Demographics
NPI:1457553315
Name:MATTHEWS, JOHN DAVID (RN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 874592
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-4592
Mailing Address - Country:US
Mailing Address - Phone:907-357-4378
Mailing Address - Fax:
Practice Address - Street 1:4203 W SUNRISE DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-9248
Practice Address - Country:US
Practice Address - Phone:907-357-4378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK18201163WE0003X, 163WF0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WE0003XNursing Service ProvidersRegistered NurseEmergency
Not Answered163WF0300XNursing Service ProvidersRegistered NurseFlight