Betty Nyaboke Matieso, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

2478964 Issued in MN

Practice address

7691 Central Avenue NE, Suite 102
Fridley, MN 55432-3560

Phone

(763) 572-2390

Fax

(763) 574-2459

NPI assigned

Nov 3, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pride N Living Home Care Inc .

  • Nursing Facility/Intermediate Care Facility
  • Fridley, MN
  • NPI 1144370610
  NPD (past)

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

{
    "created_epoch": "1667433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667433600000",
    "number": "1942917307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7691 CENTRAL AVENUE NE, SUITE 102",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554323560",
            "telephone_number": "763-572-2390",
            "fax_number": "763-574-2459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7691 CENTRAL AVENUE NE, SUITE 102",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554323560",
            "telephone_number": "763-572-2390",
            "fax_number": "763-574-2459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATIESO",
        "first_name": "BETTY",
        "middle_name": "NYABOKE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-03",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "2478964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martha'S Open Hands PLLC
• Alfredo A Massa Succar, M.D.
• Benhilldah Massaley
• Troy Philip Mathias
• Kylie Renee Anne Mathieu, LADC
• Dorothy Mattson
• Lisa R Mattson, M.D.
• John David Matzoll, ATC
• Marc Maus, LICSW
• Amy Kirsten Maynard, RN, MS, CCCRN, CCNS

• Registered Nurse in Fridley, MN
• Providers in Fridley, MN by specialty
• Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; 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.