Provider Demographics
NPI:1447556683
Name:MATTICK, JOY MINDEN (LPN)
Entity Type:Individual
Prefix:MISS
First Name:JOY
Middle Name:MINDEN
Last Name:MATTICK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 STONEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-2503
Mailing Address - Country:US
Mailing Address - Phone:612-227-6569
Mailing Address - Fax:
Practice Address - Street 1:457 STONEWOOD LN
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-2503
Practice Address - Country:US
Practice Address - Phone:612-227-6569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-06
Last Update Date:2011-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL650036164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN12301974Medicare Oscar/Certification