Individual
NIKKI ISIS MATUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
101 NICOLLS RD, STONY BROOK, NY 11794-0001
(631) 807-4241
Mailing address
14 ALLYSON PL, EAST SETAUKET, NY 11733-2000
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
310367
NY
Other
Enumeration date
06/16/2022
Last updated
06/16/2022
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