Provider Demographics
NPI:1679342661
Name:MATTHEWS, KATINA
Entity type:Individual
Prefix:
First Name:KATINA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
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 171
Mailing Address - Street 2:
Mailing Address - City:BANCROFT
Mailing Address - State:MI
Mailing Address - Zip Code:48414-0171
Mailing Address - Country:US
Mailing Address - Phone:989-408-8816
Mailing Address - Fax:
Practice Address - Street 1:210 S SHIAWASSEE ST
Practice Address - Street 2:
Practice Address - City:BANCROFT
Practice Address - State:MI
Practice Address - Zip Code:48414-7706
Practice Address - Country:US
Practice Address - Phone:989-408-8816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider