Provider Demographics
NPI:1427257997
Name:MATTHEW, JERMAINE ORLANDO (LPN)
Entity type:Individual
Prefix:
First Name:JERMAINE
Middle Name:ORLANDO
Last Name:MATTHEW
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 N HILLS LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-1030
Mailing Address - Country:US
Mailing Address - Phone:314-591-8801
Mailing Address - Fax:
Practice Address - Street 1:4700 N HILLS LN
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-1030
Practice Address - Country:US
Practice Address - Phone:314-591-8801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
343900000X
MO2007012721164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)