Provider Demographics
NPI:1922817816
Name:SUPULVER, MATTHEW P (AEMT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:SUPULVER
Suffix:
Gender:M
Credentials:AEMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3921
Mailing Address - Country:US
Mailing Address - Phone:435-231-9277
Mailing Address - Fax:
Practice Address - Street 1:634 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3921
Practice Address - Country:US
Practice Address - Phone:435-231-9277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider