Provider Demographics
NPI:1386856169
Name:MATTHEWS, HOLLIE L (MD)
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:L
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 NAT WASHINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1995
Mailing Address - Country:US
Mailing Address - Phone:509-754-3330
Mailing Address - Fax:
Practice Address - Street 1:220 NAT WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1995
Practice Address - Country:US
Practice Address - Phone:509-754-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00048127207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1386856169Medicaid
WA8945035Medicare PIN
WA8947147OtherCV
WA8509812Medicaid
WA0235121OtherL&I