Doctor Name: | MICHAEL CHARLES MATSON |
NPI Number: | 1063762490 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | ARNP |
License Number: | 125001 |
Business Practice Address: | 4500 Utica Ridge Rd Bettendorf, IA - 527221626 |
Business Phone Number: | 5637425000 |
Business Fax Number: | |
Mailing Address: | 4500 Utica Ridge Rd, BETTENDORF |
State: | IA |
Postal Code: | 527221626 |
Phone Number: | 5637425000 |
Fax Number: | |
NPI Enumeration Date: | 09/13/2012 |
NPI Last Update Date: | 09/13/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2100X |
License Number: | 125001 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Acute Care |
Taxonomy Definition: |