Provider Demographics
NPI:1871171637
Name:MATWIEJCZYK, OLIVIA MCKEEVER
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MCKEEVER
Last Name:MATWIEJCZYK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3329 EXPRESS CT
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-3278
Mailing Address - Country:US
Mailing Address - Phone:920-733-5900
Mailing Address - Fax:
Practice Address - Street 1:3329 EXPRESS CT
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-3278
Practice Address - Country:US
Practice Address - Phone:920-733-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5399-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant