Provider Demographics
NPI:1023717790
Name:QUERAL, MATTHEW RYAN (SRNA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RYAN
Last Name:QUERAL
Suffix:
Gender:M
Credentials:SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-1040
Mailing Address - Country:US
Mailing Address - Phone:503-298-8895
Mailing Address - Fax:
Practice Address - Street 1:1414 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-1040
Practice Address - Country:US
Practice Address - Phone:503-298-8895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ID51573163WC0200X
WARN60616025163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine