Individual
ALICE MATUKAITIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
10 E INDEPENDENCE ST, SHAMOKIN, PA 17872-6804
(570) 648-0582
Mailing address
4612 WESTBRANCH HWY, LEWISBURG, PA 17837
(570) 523-3462
Taxonomy
Speciality
Code
Description
License number
State
163WW0101X
Ambulatory Women's Health Care Registered Nurse
Primary
RN507564L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50004271
BLUE CROSS PROVIDER NO.
PA
01
—
MA1332162
BLUE SHIELD PROVIDER NO.
PA
Enumeration date
11/13/2006
Last updated
03/06/2012
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