Provider Demographics
NPI:1154777001
Name:MATHEW, MINI (FNP)
Entity type:Individual
Prefix:MRS
First Name:MINI
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SANDHILL DR
Mailing Address - Street 2:MIDDLETOWN FAMILY CARE ASSOCIATE,SUITE101, KETLAY PLAZA
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-5805
Mailing Address - Country:US
Mailing Address - Phone:302-378-4779
Mailing Address - Fax:
Practice Address - Street 1:114 SANDHILL DR
Practice Address - Street 2:MIDDLETOWN FAMILY CARE ASSOCIATE,SUITE101, KETLAY PLAZA
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5805
Practice Address - Country:US
Practice Address - Phone:302-378-4779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG 0000931363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily