Individual
MATTHEW THOMAS VANDEVENTER
Active
Individual
MATTHEW THOMAS VANDEVENTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APN, CRNA
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
209348
SC
163W00000X
Registered Nurse
26NR17755100
NJ
367500000X
Certified Registered Nurse Anesthetist
Primary
26NJ00552900
NJ
Other
Enumeration date
03/03/2015
Last updated
10/27/2020
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