Provider Demographics
NPI:1154809838
Name:MATTHEWS, DALENA CHI (NP)
Entity type:Individual
Prefix:
First Name:DALENA
Middle Name:CHI
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S RIVER RD UNIT D-2
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6734
Mailing Address - Country:US
Mailing Address - Phone:603-371-9402
Mailing Address - Fax:603-371-9409
Practice Address - Street 1:116 S RIVER RD UNIT D-2
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6734
Practice Address - Country:US
Practice Address - Phone:603-371-9402
Practice Address - Fax:603-371-9409
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH056919-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner