Individual
RITA L MATULAVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
101 STADIUM DRIVE, MORGANTOWN, WV 26506
(304) 598-4000
Mailing address
P O BOX 897, MORGANTOWN, WV 26507-0897
(304) 293-7401
(304) 293-6963
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
60036
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810011542
—
WV
01
—
9121131
MEDICARE GROUP
WV
01
—
CA7030
RAILROAD MEDICARE GROUP
WV
01
—
P00610982
RAILROAD MEDICARE
WV
Enumeration date
12/24/2007
Last updated
11/10/2008
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