Individual
TAYLOR DIANNE MATAKIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPM
Contact information
Practice address
20 12TH ST NE, FARIBAULT, MN 55021-3812
(254) 290-7702
Mailing address
20 12TH ST NE, FARIBAULT, MN 55021-3812
(254) 290-7702
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
1082
MN
176B00000X
Midwife
99386
TX
Other
Enumeration date
10/08/2019
Last updated
09/24/2020
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