Provider Demographics
NPI:1326435439
Name:MATTERN, JADE (MSN, AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:MATTERN
Suffix:
Gender:F
Credentials:MSN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21321 E OCOTILLO RD
Mailing Address - Street 2:SUITE #M131
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-5996
Mailing Address - Country:US
Mailing Address - Phone:480-636-1225
Mailing Address - Fax:480-636-8890
Practice Address - Street 1:21321 E OCOTILLO RD
Practice Address - Street 2:SUITE #M131
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-5996
Practice Address - Country:US
Practice Address - Phone:480-636-1225
Practice Address - Fax:480-636-8890
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7630363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology