Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 36463 | AZ |
N | 2080P0203X | Pediatric Critical Care Doctor | 46658 | WI |
NPI | 1194749796 |
---|---|
Provider Name | Dr. Jennifer L. Matchey |
First Address | Glendale, AZ 85306-4622 |
Second Address | Glendale, AZ 85306-4622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 16/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
784216 | (05) | AZ |
P00733600 | BCBSAZ (01) | AZ |