Provider Demographics
NPI:1982429346
Name:MATEOS, AMIE ANICO
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:ANICO
Last Name:MATEOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMEGHAY
Other - Middle Name:ANICO
Other - Last Name:MATEOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1021 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-3451
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2733 S 19TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-7054
Practice Address - Country:US
Practice Address - Phone:563-243-2262
Practice Address - Fax:563-243-2251
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator