Basic Information
| Provider Information | |||||||||
| NPI: | 1518903467 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATIC-CHAN | ||||||||
| FirstName: | NANETTE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RN, PHN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2008 ASILOMAR DR | ||||||||
| Address2: | |||||||||
| City: | ANTIOCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945098929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9257783297 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 MUIR RD | ||||||||
| Address2: | |||||||||
| City: | MARTINEZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945534668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9253722131 | ||||||||
| FaxNumber: | 9253722017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | 483018 | CA | Y | Nursing Service Providers | Registered Nurse | Community Health |
ID Information
| ID | Type | State | Issuer | Description | 483018 | 01 | CA | RN NURSING LICENSE | OTHER |