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Individual

AMBER B MATTHYSSE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS PA-C

Contact information

Practice address
1673 GEZON PKWY SW STE A, WYOMING, MI 49519-9520
(616) 243-3376
(616) 243-3377
Mailing address
1673 GEZON PKWY SW, STE A, WYOMING, MI 49519-9520
(616) 243-3376
(616) 243-3377

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601003436
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1047265
PA CERTIFICATION
MI
01
1153321047
PECOS ID
05
1558455311
MI
01
5601003436
PA LICENSE
MI
01
MI11296005
PTAN
MI
Enumeration date
10/03/2006
Last updated
02/18/2022
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