Provider Demographics
NPI:1871809707
Name:NASIS-MATUZA, MARIA ELIZABETH (MS, RN, CPNP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELIZABETH
Last Name:NASIS-MATUZA
Suffix:
Gender:F
Credentials:MS, RN, CPNP
Other - Prefix:
Other - First Name:MARIEL
Other - Middle Name:
Other - Last Name:NASIS-MATUZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RN, CPNP
Mailing Address - Street 1:47 PIONEER BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4423
Mailing Address - Country:US
Mailing Address - Phone:516-314-2717
Mailing Address - Fax:
Practice Address - Street 1:47 PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-4423
Practice Address - Country:US
Practice Address - Phone:516-314-2717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY577648-1163W00000X
NYF382490-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse