Provider Demographics
NPI:1447282652
Name:MCGUIRE, MATT E (RN)
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:E
Last Name:MCGUIRE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6168 GOLFVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1313
Mailing Address - Country:US
Mailing Address - Phone:810-244-8051
Mailing Address - Fax:
Practice Address - Street 1:6168 GOLFVIEW DR
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1313
Practice Address - Country:US
Practice Address - Phone:810-244-8051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704171241163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704171241OtherRN LICENSE