Taylor Dianne Matakis, CPM

Primary specialty

MidwifeTaxonomy code 176B00000X

License

1082 Issued in MN

Practice address

20 12TH St NE
Faribault, MN 55021-3812

Phone

(254) 290-7702

NPI assigned

Oct 8, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Taylor Dianne Muniz Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1570492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600905600000",
    "number": "1366084600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 12TH ST NE",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550213812",
            "telephone_number": "254-290-7702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 12TH ST NE",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550213812",
            "telephone_number": "254-290-7702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATAKIS",
        "first_name": "TAYLOR",
        "middle_name": "DIANNE",
        "credential": "CPM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-10-08",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "TX",
            "license": "99386",
            "primary": false
        },
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "MN",
            "license": "1082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAYLOR",
            "last_name": "MUNIZ",
            "middle_name": "DIANNE",
            "credential": "LM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Midwife in Faribault, MN
• Providers in Faribault, MN by specialty
• Midwife in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.