Provider Demographics
NPI:1538561071
Name:MATTHEWS, KATHY S (RN)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:S
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:KATE
Other - Middle Name:S
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:11 ROSEWOOD DROVE
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072
Mailing Address - Country:US
Mailing Address - Phone:781-341-3354
Mailing Address - Fax:
Practice Address - Street 1:119 WINDSOR ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3647
Practice Address - Country:US
Practice Address - Phone:617-665-3959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152121163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse