Provider Demographics
NPI:1811449853
Name:MATHIAS, ERIC (FNP)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MATHIAS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 WABASH ST
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-1132
Mailing Address - Country:US
Mailing Address - Phone:906-360-4171
Mailing Address - Fax:
Practice Address - Street 1:1301 SOLANA BLVD
Practice Address - Street 2:BLD. 2. SUITE 2200
Practice Address - City:WESTLAKE
Practice Address - State:TX
Practice Address - Zip Code:76262-1659
Practice Address - Country:US
Practice Address - Phone:817-767-6188
Practice Address - Fax:817-887-5620
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704243902163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse