Provider Demographics
NPI:1497785026
Name:MATTIS, JOSEPH GERARD (CRNP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GERARD
Last Name:MATTIS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 FORBES AT MEYRAN AVENUE
Mailing Address - Street 2:FORBES TOWER, SUITE 10028
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:412-647-5954
Mailing Address - Fax:412-864-3400
Practice Address - Street 1:3600 FORBES AT MEYRAN AVENUE
Practice Address - Street 2:FORBES TOWER, SUITE 10028
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-647-5954
Practice Address - Fax:412-864-3400
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN310230L163WE0003X
PAVP003361B163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA500011956OtherRR MEDICARE
S48911Medicare UPIN
PA500011956OtherRR MEDICARE