MEDICARE: DANIEL MATTSON, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN28323	MT

General Provider Information

NPI Number	:	1043568959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL MATTSON, P.C.

Provider Business Mailing Address
First Line	:	3111 AVENUE E
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-6548
Country	:	US
Telephone Number	:	406-490-3983
Fax Number	:

Provider Business Practice Location Address
First Line	:	3111 AVENUE E
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-6548
Country	:	US
Telephone Number	:	406-490-3983
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DANIEL RICHARD MATTSON
Credential	:	CRNA
Telephone Number	:	406-490-3983

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	11/24/2013

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