Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 1845 | CA |
NPI | 1093950909 |
---|---|
Provider Name | Courtney Anne Matson |
First Address | Ukiah, CA 95482-6540 |
Second Address | Ukiah, CA 95482-6540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2008 |
Last Update Date | 05/12/2008 |