Organization
AMANDA MATJE PA-C PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VANESSA KOZIOL (CREDENTIALING)
(480) 376-6456
Entity
Organization
Contact information
Practice address
7600 N 15TH ST, PHOENIX, AZ 85020-4327
(602) 395-0718
Mailing address
PO BOX 39179, PHOENIX, AZ 85069-9179
(602) 395-0718
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PEND
PEND
AZ
Enumeration date
05/05/2022
Last updated
05/05/2022
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