Provider Demographics
NPI:1457704819
Name:KIIO, MATHEW (DNP)
Entity Type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:
Last Name:KIIO
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 CANAL ST FL 6E
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1244
Mailing Address - Country:US
Mailing Address - Phone:978-770-5743
Mailing Address - Fax:
Practice Address - Street 1:599 CANAL ST FL 6E
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1244
Practice Address - Country:US
Practice Address - Phone:978-770-5743
Practice Address - Fax:888-900-1291
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAG0316182363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA363LP080XOtherNURSE PRACTITIONER