Provider Demographics
NPI:1528808227
Name:JOHNTONY, MATTHEW JOHN (CRNP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOHN
Last Name:JOHNTONY
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 170
Mailing Address - Street 2:
Mailing Address - City:BAKERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15007-0170
Mailing Address - Country:US
Mailing Address - Phone:724-674-7854
Mailing Address - Fax:
Practice Address - Street 1:555 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:PA
Practice Address - Zip Code:16038-1623
Practice Address - Country:US
Practice Address - Phone:724-735-4224
Practice Address - Fax:724-735-0103
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP029783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily