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NPI Code Detail

MEDICARE: MRS. JESSICA MARIE MATTIA-BARRY DNP, FNP-C

MEDICARE: MRS. JESSICA MARIE MATTIA-BARRY DNP, FNP-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
1163WG0000XGeneral Practice Registered Nurse219474-30WI
2363LF0000XFamily Nurse Practitioner1340833WI

General Provider Information

NPI Number : 1588940951
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA MARIE MATTIA-BARRY DNP, FNP-C
Provider Business Mailing Address
First Line : N5361 MEADOWLARK RD
Second Line :
City : SHEBOYGAN FLS
State : WI
Zip : 53085-2504
Country : US
Telephone Number : 520-419-1534
Fax Number :
Provider Business Practice Location Address
First Line : 1721 SAEMANN AVE
Second Line :
City : SHEBOYGAN
State : WI
Zip : 53081-2342
Country : US
Telephone Number : 920-783-6633
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2011
Last Update Date : 04/04/2023

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