Provider Demographics
NPI:1649806050
Name:MATTHEWS, LATOYA RENEE (APRN, FNP)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:RENEE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4179 S RIVERBOAT RD STE 220
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2986
Mailing Address - Country:US
Mailing Address - Phone:801-921-6816
Mailing Address - Fax:
Practice Address - Street 1:7201 W LAKE MEAD BLVD STE 112
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-8362
Practice Address - Country:US
Practice Address - Phone:702-703-5160
Practice Address - Fax:702-946-5052
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014209363LF0000X
NV829693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily