Mattingly, Sally S.
Mattingly, Sally S. is an individual health care provider with primary practice located at 2400 Pine Ridge Blvd , Wausau WI 54401-7803. She recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as her primary health care specialty. Mattingly, Sally S. can be contacted via phone (715) 847-2022.Contact Information
Primary practice address
2400 Pine Ridge Blvd
Wausau WI 54401-7803
Phone: (715) 847-2022
Fax: (715) 847-2775
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 28953 | Wisconsin |
Profile Details
| NPI number | 1558363366 |
|---|---|
| LBN Legal business name | Mattingly, Sally S. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 11th, 2005 |
| Last updated | Jan 28th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1558363366 | NPPES |
| Wisconsin | MEDICAID | 30859700 |
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