Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 1008924 | TX |
NPI | 1023629136 |
---|---|
Provider Name | Mr. Matthew David Piehler |
First Address | San Antonio, TX 78258-4946 |
Second Address | Salem, OR 97301-0100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2020 |
Last Update Date | 05/10/2021 |