Provider Demographics
NPI:1790677714
Name:HATHCOCK, MATTHEW DAVID (MSN RN)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DAVID
Last Name:HATHCOCK
Suffix:
Gender:M
Credentials:MSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 LONG BRIDGE ST APT 142
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2395
Mailing Address - Country:US
Mailing Address - Phone:817-240-2129
Mailing Address - Fax:
Practice Address - Street 1:690 LONG BRIDGE ST APT 142
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2395
Practice Address - Country:US
Practice Address - Phone:817-240-2129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX846701163WC0200X
CA95192399163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine