Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 215890 | NY |
NPI | 1063532125 |
---|---|
Provider Name | Kristin Ann Matteson |
First Address | Amherst, NY 14228-2792 |
Second Address | Amherst, NY 14228-2792 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 19/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02422071 | (05) | NY |
H85603 | (02) | NY |