Individual
MR. MATTHEW JAY AGNEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2900 COLLINS RD, LANSING, MI 48910-8394
(517) 377-8225
(517) 372-5006
Mailing address
1749 HAMILTON RD STE 102E, OKEMOS, MI 48864-1941
(517) 482-2118
(517) 372-5006
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704212178
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704212178
STATE LICENSE NUMBER
MI
Enumeration date
01/30/2007
Last updated
01/31/2024
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