Provider Demographics
NPI:1487995478
Name:MATTHEWS, DANITA
Entity type:Individual
Prefix:
First Name:DANITA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 THURLOW LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NC
Mailing Address - Zip Code:28327
Mailing Address - Country:US
Mailing Address - Phone:910-783-5960
Mailing Address - Fax:
Practice Address - Street 1:611 THURLOW LAKE RD
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NC
Practice Address - Zip Code:28327-8578
Practice Address - Country:US
Practice Address - Phone:910-783-5960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide