Provider Demographics
NPI:1396445631
Name:MATTERN, CHRISTY JEAN (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:JEAN
Last Name:MATTERN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 RANGE LINE RD
Mailing Address - Street 2:
Mailing Address - City:WABENO
Mailing Address - State:WI
Mailing Address - Zip Code:54566-9025
Mailing Address - Country:US
Mailing Address - Phone:715-889-0601
Mailing Address - Fax:
Practice Address - Street 1:112 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-2710
Practice Address - Country:US
Practice Address - Phone:715-623-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7261-23363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical