JENNA MARIE MATTOCKS (NPI# 1376909242) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376909242 |
| Entity Type | Individual |
| Full Name | JENNA MARIE MATTOCKS |
| Credential | PNP |
| Practice Address |
610 30th Ave W Alexandria MN 56308-3426 |
| Practice Telephone | 3207635123 |
| Practice Fax Number | 3207635749 |
| Mailing Telephone | 3207635123 |
| Mailing Fax Number | 3207635749 |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2016-01-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
CNP 4319 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | NPI | 1376909242 | 01 |
| MN | DEA | MM3759163 | 01 |
| MN | RN LICENSE | 2074717 | 01 |
| MN | CNP LICENSE | CNP 4319 | 01 |
| Street Address |
610 30TH AVE W |
| City | ALEXANDRIA |
| State | MN |
| Zip Code | 56308-3426 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528066651 | Lake Region Eye Center | Optometrist | 610 30th Ave W, Ste 200, Alexandria, MN 56308-3426 | 2005-07-12 |
| 1760005433 | Andrea L Swenson | Registered Nurse | 610 30th Ave W, Alexandria, MN 56308-3426 | 2020-05-28 |
| 1396206959 | Brooke Ann Loeffler | Dietitian, Registered | 610 30th Ave W, Alexandria, MN 56308-3426 | 2019-03-27 |
| 1427515287 | Tara Allison Reichmann | Dietitian, Registered | 610 30th Ave W, Alexandria, MN 56308-3426 | 2019-02-27 |
| 1457816027 | Alomere Health | Dietitian, Registered | 610 30th Ave W, Alexandria, MN 56308 | 2019-02-07 |
| 1306315486 | Maxwell Alan Berscheit | Nurse Practitioner | 610 30th Ave W, Alexandria, MN 56308-3426 | 2018-11-18 |
| 1598240376 | Connor William Sacks | Physician Assistant | 610 30th Ave W, Alexandria, MN 56308-3426 | 2018-09-27 |
| 1164905659 | Samantha Jean Aabel | Advanced Practice Midwife | 610 30th Ave W, Alexandria, MN 56308-3426 | 2018-09-11 |
| 1861970592 | Kelly Jean Mahoney | Physician Assistant | 610 30th Ave W, Alexandria, MN 56308-3426 | 2018-08-03 |
| 1205365830 | Skyler Holte Dahlseng | Internal Medicine | 610 30th Ave W, Alexandria, MN 56308-3426 | 2017-06-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871104836 | Center for Pain Management Ambulatory Surgery, Ltd | Pain Medicine | 804 23rd Street South, Sartell, MN 56308 | 2020-08-13 |
| 1548815590 | Ritajo Ellenberger | Licensed Practical Nurse | 220 Oak Street North, Alexandria, MN 56308 | 2019-08-06 |
| 1346808714 | Vance Thompson Vision Surgery Center Alexandria, Prof LLC | Clinic/Center | 2600 Jefferson St, Alexandria, MN 56308 | 2019-05-31 |
| 1811452048 | Little Falls Eye Care Center Pa | Optometrist | 2306 S. Broadway Str. Suite 12, Alexandria, MN 56308 | 2019-02-01 |
| 1184167199 | Jennifer Lynn Craig | Technician | 2307 East Golf Course Rd, Alexandria, MN 56308 | 2016-11-22 |
| 1548712219 | Shelby Elisha Johnsrud | Chiropractor | 303 West 22nd Ave, Ste 100, Alexandria, MN 56308 | 2016-10-28 |
| 1811347867 | Dustin Matthew Ditch | Dentist | 510 22nd Ave E Ste 702, Alexandria, MN 56308 | 2016-06-20 |
| 1639538051 | West Central Chiropractic & Wellness, LLC | Chiropractor | 123 3rd Ave. E, Suite 100, Alexandria, MN 56308 | 2016-02-12 |
| 1659736221 | Amanda Jean Dahlseng | Registered Nurse | 809 Elm Street, Suite 1200, Alexandria, MN 56308 | 2015-12-23 |
| 1518358886 | Benjamin G Wenzel | Marriage & Family Therapist | 512 30th Ave S, Ste 100, Alexandria, MN 56308 | 2015-02-09 |
| Find all providers in zip 56308 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669097978 | Madison Smith | Nurse Practitioner | 1220 Wythe St Apt 258, Alexandria, VA 22314-2279 | 2020-06-11 |
| 1013542349 | Juliet Brown | Nurse Practitioner | 5249 Duke St Ste 303, Alexandria, VA 22304-2907 | 2020-03-06 |
| 1033679501 | Laura Elizabeth Williamson | Nurse Practitioner | 501 Medical Center Dr Ste 100, Alexandria, LA 71301-8124 | 2019-03-21 |
| 1275076101 | Judith Stewart Wackenhut | Nurse Practitioner | 545 Triadelphia Way, Alexandria, VA 22312-3496 | 2016-11-26 |
| 1811304629 | Chasity D Amy | Nurse Practitioner | 6318 Bayou Crossing Dr, Alexandria, LA 71303-7028 | 2014-07-14 |
| 1366408817 | Paula A Manion | Nurse Practitioner | 6303 Little River Tpke, # 300, Alexandria, VA 22312 | 2006-04-25 |
| 1801852355 | Theresa P Tangherlini | Nurse Practitioner | 6303 Little River Tpke #300, Alexandria, VA 22312 | 2006-04-25 |
| 1548252760 | Linda M Paul | Nurse Practitioner | 3330 Masonic Dr, Alexandria, LA 71301-3841 | 2005-08-16 |
| 1669474797 | Carolyn Sue Lemoine | Nurse Practitioner | St. Frances Cabrini Hospital School Based Centers, 3330 Masonic Dr., Alexandria, LA 71301 | 2005-06-01 |
| 1083225940 | Ranassa Renee Smith | Nurse Practitioner | 2226 Worley Dr, Alexandria, LA 71301-3600 | 2020-08-13 |
| Find all providers in ALEXANDRIA | ||||
| City | ALEXANDRIA |
| Zip Code | 56308 |
Please comment or provide details below to improve the information on JENNA MARIE MATTOCKS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.