Healthcare Provider Details

I. General information

NPI: 1649549890
Provider Name (Legal Business Name): NANDA CATHERINE MATTESON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 FULTON MALL CMS - CCS, 2ND FLOOR
FRESNO CA
93721-1915
US

IV. Provider business mailing address

PO BOX 11867
FRESNO CA
93775-1867
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-3200
  • Fax: 559-600-7687
Mailing address:
  • Phone: 599-600-3200
  • Fax: 559-600-7687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number704255
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: