Provider Demographics
NPI:1346610813
Name:MATTAS, MARY LOUISE (ARNP-C, CRNFA)
Entity Type:Individual
Prefix:
First Name:MARY LOUISE
Middle Name:
Last Name:MATTAS
Suffix:
Gender:F
Credentials:ARNP-C, CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 17TH AVE N
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-6432
Mailing Address - Country:US
Mailing Address - Phone:561-727-9260
Mailing Address - Fax:
Practice Address - Street 1:1832 17TH AVE N
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-6432
Practice Address - Country:US
Practice Address - Phone:561-727-9260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-28
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9175209163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant