Provider Demographics
NPI:1881682052
Name:MATTIE, CATHERINE FAYE (APN)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:FAYE
Last Name:MATTIE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14303 W AMELIA AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-8444
Mailing Address - Country:US
Mailing Address - Phone:623-856-9708
Mailing Address - Fax:623-856-8255
Practice Address - Street 1:56TH MEDICAL GROUP
Practice Address - Street 2:7219 LITCHFIELD ROAD
Practice Address - City:LUKE AIR FORCE BASE
Practice Address - State:AZ
Practice Address - Zip Code:85309-1525
Practice Address - Country:US
Practice Address - Phone:623-856-4032
Practice Address - Fax:623-856-8803
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9167047363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology