Provider Demographics
NPI:1043529746
Name:GIFFORD, MATTHEW STEPHAN (RNFA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:STEPHAN
Last Name:GIFFORD
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15173 W LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8181
Mailing Address - Country:US
Mailing Address - Phone:623-533-3601
Mailing Address - Fax:
Practice Address - Street 1:15173 W LARKSPUR DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-8181
Practice Address - Country:US
Practice Address - Phone:623-533-3601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ145764163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant