Provider Demographics
NPI:1881135325
Name:IAMMATTEO, MONICA MARIE
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:MARIE
Last Name:IAMMATTEO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:MARIE
Other - Last Name:IAMMATTEO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:261 SIDNEY ST W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-3406
Mailing Address - Country:US
Mailing Address - Phone:651-487-4213
Mailing Address - Fax:
Practice Address - Street 1:261 SIDNEY ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-3406
Practice Address - Country:US
Practice Address - Phone:651-487-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA1119174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator