Individual
MRS. BRANDY RENEE MATUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
182 SW ACADEMY ST, DALLAS, OR 97338-1922
(503) 623-9289
Mailing address
182 SW ACADEMY ST, DALLAS, OR 97338-1922
(503) 623-9289
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201130493LPN
OR
Other
Enumeration date
06/18/2012
Last updated
06/18/2012
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