Provider Demographics
NPI:1912978677
Name:MATTLAGE, LINDA C (ARNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:MATTLAGE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:248 PLEASANT ST
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2588
Mailing Address - Country:US
Mailing Address - Phone:603-224-1929
Mailing Address - Fax:603-228-7114
Practice Address - Street 1:248 PLEASANT ST
Practice Address - Street 2:SUITE 1700
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2588
Practice Address - Country:US
Practice Address - Phone:603-224-1929
Practice Address - Fax:603-228-7114
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH021052-23-02363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30008658Medicaid
22258YOtherUPIN