Basic Information
| Provider Information | |||||||||
| NPI: | 1740224880 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATTY | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2940 | ||||||||
| Address2: | |||||||||
| City: | POULSBO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983702940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3609790569 | ||||||||
| FaxNumber: | 8778059505 | ||||||||
| Practice Location | |||||||||
| Address1: | 19980 10TH AVE NE STE 202 | ||||||||
| Address2: | |||||||||
| City: | POULSBO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983706322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3609790569 | ||||||||
| FaxNumber: | 8778059505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 04/10/2019 | ||||||||
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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 | 207VX0000X | MD00041619 | WA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | 207Q00000X | MD00041619 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8918MA | 01 | REGENCE BLUE SHIELD | OTHER | 172437 | 01 | WA | LABOR & INDUSTRIES | OTHER | 1017760 | 05 | WA | MEDICAID | P00045620 | 01 | RAILROAD MEDICARE | OTHER | BM7970076 | 01 | DEA | OTHER | 7810457 | 01 | AETNA | OTHER |