Basic Information
| Provider Information | |||||||||
| NPI: | 1356385496 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATTHEWS | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BELGRADE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597143847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063888708 | ||||||||
| FaxNumber: | 4063888710 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BELGRADE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597143847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063888708 | ||||||||
| FaxNumber: | 4063888710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 07/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R814478 | MS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | NUR-RN-LIC-74827 | MT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 00122887 | 05 | MS | MEDICAID | 202011213A | 01 | MS | BLUE CROSS | OTHER | P00227076 | 01 | MS | RAILROAD MEDICARE | OTHER |