Provider Demographics
NPI:1841926367
Name:MATTOX, DAVID II (RN)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MATTOX
Suffix:II
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 BETHANY RD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-9669
Mailing Address - Country:US
Mailing Address - Phone:765-393-9083
Mailing Address - Fax:
Practice Address - Street 1:1707 BETHANY RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-9669
Practice Address - Country:US
Practice Address - Phone:765-393-9083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28212055A163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator