MEDICARE: NANCY LYNN MATTONI NURSE PRACTIONER

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	363L00000X	Nurse Practitioner	4704109576	MI

General Provider Information

NPI Number	:	1316020902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY LYNN MATTONI NURSE PRACTIONER

Provider Business Mailing Address
First Line	:	332 W TIENKEN RD
Second Line	:	SUITE B
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48306-4473
Country	:	US
Telephone Number	:	248-656-1300
Fax Number	:	248-656-7459

Provider Business Practice Location Address
First Line	:	332 W TIENKEN RD
Second Line	:	SUITE B
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48306-4473
Country	:	US
Telephone Number	:	248-656-1300
Fax Number	:	248-656-7459

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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