Provider Demographics
NPI:1164305553
Name:BASKWELL, MATTHEW (RN, MSN, ACCNS-AG)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BASKWELL
Suffix:
Gender:M
Credentials:RN, MSN, ACCNS-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3973
Mailing Address - Country:US
Mailing Address - Phone:315-723-3779
Mailing Address - Fax:
Practice Address - Street 1:676 FUTENMA, GINOWAN
Practice Address - Street 2:OKINAWA 901-2202
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96379-0003
Practice Address - Country:US
Practice Address - Phone:819-971-9335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95308083364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care