Provider Demographics
NPI:1780307694
Name:MATTHEWS, MARILYN MARCIA (RN)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:MARCIA
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44747 RUTHRON AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-1431
Mailing Address - Country:US
Mailing Address - Phone:661-952-8878
Mailing Address - Fax:
Practice Address - Street 1:5001 W AVENUE N
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-2989
Practice Address - Country:US
Practice Address - Phone:661-722-5892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA375061163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse