Provider Demographics
NPI:1760710172
Name:MATTLIN, HARRIET JEAN (NP)
Entity Type:Individual
Prefix:
First Name:HARRIET
Middle Name:JEAN
Last Name:MATTLIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 E MCANDREWS RD SUITE 202
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-773-3688
Mailing Address - Fax:541-773-3125
Practice Address - Street 1:1322 E MCANDREWS RD STE 202
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6177
Practice Address - Country:US
Practice Address - Phone:541-773-3688
Practice Address - Fax:541-773-3125
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201400209RN363L00000X
CA15398363L00000X, 363LF0000X
OR201400210NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201400210NP-PPOtherOREGON LICENSE
OR38-3990OtherMEDICARE PART A
OR930937095OtherCURRY HEALTH DISTRICT
CANP 15398OtherNP LICENSE
ORR0000ZGBDGOtherCURRY GENERAL HOSPITAL MEDICARE PART B
CARN 389101OtherRN LICENSE
CARN 389101OtherRN LICENSE