Individual
MATTHEW PAUL WOLTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2300 N EDWARD ST, DECATUR, IL 62526
(217) 876-8121
(217) 876-2261
Mailing address
2300 N EDWARD ST, ATT BUSINESS OFFICE, DECATUR, IL 62526
(217) 876-8121
(217) 876-2261
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209006102
IL
Other
Enumeration date
10/04/2006
Last updated
03/01/2019
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