Provider Demographics
NPI:1487907838
Name:MATUS, TERESA MARIE (CRNA)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:MATUS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5702 N 18TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-2602
Mailing Address - Country:US
Mailing Address - Phone:602-770-6114
Mailing Address - Fax:
Practice Address - Street 1:8901 E RAINTREE DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7026
Practice Address - Country:US
Practice Address - Phone:480-767-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA0892367500000X
AZCRNA0892367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered