Provider Demographics
NPI:1588393706
Name:PRINS, MATTEA LAUREN (PA)
Entity type:Individual
Prefix:
First Name:MATTEA
Middle Name:LAUREN
Last Name:PRINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 IOWA AVE SW APT 3
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51041-1580
Mailing Address - Country:US
Mailing Address - Phone:605-321-9971
Mailing Address - Fax:
Practice Address - Street 1:705 IOWA AVE SW APT 3
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:IA
Practice Address - Zip Code:51041-1580
Practice Address - Country:US
Practice Address - Phone:605-321-9971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program