Basic Information
| Provider Information | |||||||||
| NPI: | 1558096453 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HASELTON | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | RAYMOND | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 FAIRGATE LN | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959267793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254878572 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1040 MANGROVE AVE | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959263509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303450064 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2022 | ||||||||
| LastUpdateDate: | 07/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 95021784 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.