Provider Demographics
NPI:1497523328
Name:MATHIS, JOHN (RN)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:MATHIS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2702 OBERLIN DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-1631
Mailing Address - Country:US
Mailing Address - Phone:941-387-5558
Mailing Address - Fax:
Practice Address - Street 1:2702 OBERLIN DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-1631
Practice Address - Country:US
Practice Address - Phone:941-387-5558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC263018163WP0200X, 163WX0200X, 207ZC0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0008XAllopathic & Osteopathic PhysiciansPathologyClinical Informatics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WX0200XNursing Service ProvidersRegistered NurseOncology