Provider Demographics
NPI:1548519747
Name:MATHEWS, SIGRUN OLSEN (LPN)
Entity type:Individual
Prefix:MRS
First Name:SIGRUN
Middle Name:OLSEN
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:ROSENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12472-9718
Mailing Address - Country:US
Mailing Address - Phone:845-658-9739
Mailing Address - Fax:
Practice Address - Street 1:102 JAMES ST
Practice Address - Street 2:
Practice Address - City:ROSENDALE
Practice Address - State:NY
Practice Address - Zip Code:12472-9718
Practice Address - Country:US
Practice Address - Phone:845-658-9739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145158164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse