Provider Demographics
NPI:1043568959
Name:DANIEL MATTSON, P.C.
Entity Type:Organization
Organization Name:DANIEL MATTSON, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MATTSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:406-490-3983
Mailing Address - Street 1:3111 AVENUE E
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6548
Mailing Address - Country:US
Mailing Address - Phone:406-490-3983
Mailing Address - Fax:
Practice Address - Street 1:3111 AVENUE E
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6548
Practice Address - Country:US
Practice Address - Phone:406-490-3983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2013-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN28323367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty