Provider Demographics
NPI:1700697703
Name:MATVEYUK, INNA
Entity type:Individual
Prefix:MRS
First Name:INNA
Middle Name:
Last Name:MATVEYUK
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 1:1701 ENOCH DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-4437
Mailing Address - Country:US
Mailing Address - Phone:319-383-4626
Mailing Address - Fax:
Practice Address - Street 1:1701 ENOCH DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-4437
Practice Address - Country:US
Practice Address - Phone:319-383-4626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99584176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife