Provider Demographics
NPI:1902504830
Name:MATTHEW, ANNU
Entity Type:Individual
Prefix:
First Name:ANNU
Middle Name:
Last Name:MATTHEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2011
Mailing Address - Country:US
Mailing Address - Phone:610-940-2011
Mailing Address - Fax:610-940-2605
Practice Address - Street 1:615 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2011
Practice Address - Country:US
Practice Address - Phone:610-940-2011
Practice Address - Fax:610-940-2605
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027096363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health