Mattise, Dorothy L

Mattise, Dorothy L is an individual health care provider with primary practice located at 1055 N Curtis Rd , Boise ID 83706-1352. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered. Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered is her primary health care specialty. Mattise, Dorothy L can be contacted via phone (208) 367-6416.

Contact Information

Primary practice address
1055 N Curtis Rd Boise ID 83706-1352
Phone: (208) 367-6416
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X N7765 Idaho
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X RNA120 Idaho

Profile Details

NPI number 1457306870
LBN Legal business name Mattise, Dorothy L
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date May 24th, 2006
Last updated Apr 7th, 2011 - about 13 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457306870 NPPES
Idaho MEDICAID 004378300

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