Basic Information
| Provider Information | |||||||||
| NPI: | 1538156351 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATUK | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | BURTON | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 277 | ||||||||
| Address2: | |||||||||
| City: | BIEBER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960090277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302945241 | ||||||||
| FaxNumber: | 5302945241 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 S CHILOQUIN BLVD | ||||||||
| Address2: | |||||||||
| City: | CHILOQUIN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976246747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417833293 | ||||||||
| FaxNumber: | 5417833273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 03/18/2016 | ||||||||
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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 | 363LF0000X | 094006651N1 | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 276266 | 05 | OR | MEDICAID |