Provider Demographics
NPI:1275930943
Name:MATTUCCI, MARIO LUIGI (RN)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:LUIGI
Last Name:MATTUCCI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 LANGTRY ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-2010
Mailing Address - Country:US
Mailing Address - Phone:412-512-3294
Mailing Address - Fax:
Practice Address - Street 1:917 LANGTRY ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-2010
Practice Address - Country:US
Practice Address - Phone:412-512-3294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN569401163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse