Basic Information
| Provider Information | |||||||||
| NPI: | 1588796056 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATZ | ||||||||
| FirstName: | MARIANNE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 JOHNSON ST | ||||||||
| Address2: | |||||||||
| City: | FRAMINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017014141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088772247 | ||||||||
| FaxNumber: | 5084052529 | ||||||||
| Practice Location | |||||||||
| Address1: | 354 WAVERLY ST | ||||||||
| Address2: | |||||||||
| City: | FRAMINGHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017027079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082705700 | ||||||||
| FaxNumber: | 5088756215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2007 | ||||||||
| LastUpdateDate: | 12/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 231546 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.