Provider Demographics
NPI:1174113476
Name:HUELSMANN, MATTHEW (FNP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:HUELSMANN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HAIRPIN DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62026-0001
Mailing Address - Country:US
Mailing Address - Phone:618-650-5555
Mailing Address - Fax:
Practice Address - Street 1:16 EXECUTIVE DR STE 100
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-1366
Practice Address - Country:US
Practice Address - Phone:618-622-9073
Practice Address - Fax:618-622-9230
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041462133390200000X
IL209025525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program