Provider Demographics
NPI:1093325656
Name:MATT, TAMMI ANNETTE
Entity Type:Individual
Prefix:
First Name:TAMMI
Middle Name:ANNETTE
Last Name:MATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 COOK ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51103-3707
Mailing Address - Country:US
Mailing Address - Phone:712-233-4144
Mailing Address - Fax:
Practice Address - Street 1:309 COOK ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51103-3707
Practice Address - Country:US
Practice Address - Phone:712-233-4144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA160264363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily