Individual
MRS. ANN M MATAKAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
603 W COUNTRY CLUB RD, ROSWELL, NM 88201-5211
(575) 624-4922
(575) 624-4902
Mailing address
603 W COUNTRY CLUB RD, ROSWELL, NM 88201-5211
(575) 624-4922
(575) 624-4902
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
691067
TX
363LF0000X
Family Nurse Practitioner
Primary
CNP-03502
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1265793319
BCBS NM
NM
01
—
634354YYH0
MEDICARE
NM
05
—
79679021
—
NM
Enumeration date
06/05/2012
Last updated
11/05/2024
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