HARRIET JEAN MATTLIN (NPI# 1760710172) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760710172 |
| Entity Type | Individual |
| Full Name | HARRIET JEAN MATTLIN |
| Credential | NP |
| Practice Address |
1322 E Mcandrews Rd Ste 202 Medford OR 97504-6177 |
| Mailing Address |
1322 E Mcandrews Rd Suite 202 Medford OR 97504 |
| Practice Telephone | 5417733688 |
| Practice Fax Number | 5417733125 |
| Mailing Telephone | (541) 773-3688 |
| Mailing Fax Number | 5417733125 |
| Enumeration Date | 2009-11-23 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 201400209RN | OR | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363L00000X | Nurse Practitioner | 15398 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
201400210NP-PP | OR | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
15398 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | OREGON LICENSE | 201400210NP-PP | 01 |
| OR | CURRY HEALTH DISTRICT | 930937095 | 01 |
| OR | DEA CERTIFICATE | MM2123519 | 01 |
| CA | NP LICENSE | NP 15398 | 01 |
| CA | RN LICENSE | RN 389101 | 01 |
| OR | MEDICARE PART A | 38-3990 | 01 |
| OR | CURRY GENERAL HOSPITAL MEDICARE PART B | R0000ZGBDG | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 525 Madrona Ave, Port Orford, OR 974659552 | 5413323861 | 5413320250 |
| Street Address |
1322 E MCANDREWS RD STE 202 |
| City | MEDFORD |
| State | OR |
| Zip Code | 97504-6177 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154424158 | Laura Balestreri | Pediatrics | 1322 E Mcandrews Rd Ste 202, Medford, OR 97504-6177 | 2006-09-06 |
| 1164505525 | Cheryl Lynn Pippin | Nurse Practitioner | 1322 E Mcandrews Rd Ste 202, Medford, OR 97504-6177 | 2006-10-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
| 1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
| 1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
| 1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
| 1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
| 1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
| 1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
| 1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
| Find all providers in zip 97504 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679113922 | Elena Chapman | Nurse Practitioner | 293 Salem St 4, Medford, MA 02155 | 2020-01-14 |
| 1770005407 | Suzanne Ellen Sanderson | Nurse Practitioner | 2620 E Barnett Rd Ste H, Medford, OR 97504-8383 | 2017-07-14 |
| 1194189902 | Josephine Magpantay Gaviola | Nurse Practitioner | 101 Main St Ste 116, Medford, MA 02155-4530 | 2016-04-07 |
| 1033514286 | Lauren E Hodgdon | Nurse Practitioner | 1698 E Mcandrews Rd Ste 200, Medford, OR 97504 | 2014-10-30 |
| 1962820209 | Jessica Anne Marie Gunn | Nurse Practitioner | 21 Ohio Trl, Medford, NJ 08055-8931 | 2014-04-03 |
| 1912333451 | Travis Adam Day | Nurse Practitioner | 70 Bower Dr Ste 110, Medford, OR 97501-3689 | 2013-09-16 |
| 1184058703 | Ashley Riley | Nurse Practitioner | 101 Main St Ste 107, Medford, MA 02155-4530 | 2013-08-30 |
| 1578841169 | Shannon Jamerson | Nurse Practitioner | 619 N Front St, Medford, OK 73759-2704 | 2011-07-29 |
| 1891081113 | Debra Jeanne Zenner | Nurse Practitioner | 143 South Gibson St., Medford, WI 54451 | 2011-06-24 |
| 1366763336 | Edward William Walton | Nurse Practitioner | 2 Pinecrest Dr, Medford, NJ 08055-8513 | 2010-06-14 |
| Find all providers in MEDFORD | ||||
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| 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.