Provider Demographics
NPI:1568643831
Name:MATHIS, DANA SUE (FNP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:SUE
Last Name:MATHIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 W RIVERSIDE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1109
Mailing Address - Country:US
Mailing Address - Phone:907-656-1366
Mailing Address - Fax:
Practice Address - Street 1:150 FRONT ST
Practice Address - Street 2:
Practice Address - City:TANANA
Practice Address - State:AK
Practice Address - Zip Code:99777
Practice Address - Country:US
Practice Address - Phone:907-656-1366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5959090-4405363LF0000X
AKNURU1318363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily