Provider Demographics
NPI:1699313155
Name:NAGELBUSH, MATTHEW DAVID
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DAVID
Last Name:NAGELBUSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28342 N 64TH LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083
Mailing Address - Country:US
Mailing Address - Phone:623-205-3445
Mailing Address - Fax:
Practice Address - Street 1:11036 N 23RD AVE STE 7
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4800
Practice Address - Country:US
Practice Address - Phone:623-205-3445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health