Provider Demographics
NPI:1447083068
Name:MATSON, ELISE AMANDA (FNP)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:AMANDA
Last Name:MATSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 CONOR CT
Mailing Address - Street 2:
Mailing Address - City:BLUE GRASS
Mailing Address - State:IA
Mailing Address - Zip Code:52726-9613
Mailing Address - Country:US
Mailing Address - Phone:563-770-0620
Mailing Address - Fax:
Practice Address - Street 1:564 CONOR CT
Practice Address - Street 2:
Practice Address - City:BLUE GRASS
Practice Address - State:IA
Practice Address - Zip Code:52726-9613
Practice Address - Country:US
Practice Address - Phone:563-770-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF02241144363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily