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Individual

DEIDRE MATTHEWS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
21371 RIDGEDALE ST, OAK PARK, MI 48237-2707
(248) 943-8733
Mailing address
21371 RIDGEDALE ST, OAK PARK, MI 48237-2707
(248) 943-8733

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704237355
MI
363LF0000X
Family Nurse Practitioner
Primary
4704237355
MI

Other

Enumeration date
02/14/2018
Last updated
05/03/2021
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