Provider Demographics
NPI:1184991234
Name:DRAPER, MATTHEW LEWIS (FNP-C, RN, AT, ATC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LEWIS
Last Name:DRAPER
Suffix:
Gender:M
Credentials:FNP-C, RN, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11228 SAND HILL DR
Mailing Address - Street 2:
Mailing Address - City:GRASS LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49240-9688
Mailing Address - Country:US
Mailing Address - Phone:517-398-4042
Mailing Address - Fax:
Practice Address - Street 1:956 COOPER ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3398
Practice Address - Country:US
Practice Address - Phone:517-998-6574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704318832163WE0003X, 363LF0000X
MI26010001402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer