Provider Demographics
NPI:1811278559
Name:MATTUS, JESSICA M (NP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:M
Last Name:MATTUS
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:MGH DEPT OF ANESTHESIA, CRIT CARE AND PAIN
Mailing Address - Street 2:55 FRUIT STREET, GRB 444
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2696
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 1ST AVENUE
Practice Address - Street 2:15 EAST SICU
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:508-404-6518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN276482363L00000X, 363LA2100X
NYF430649-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care