Healthcare Provider Details

I. General information

NPI: 1891101267
Provider Name (Legal Business Name): KRISTIN MATTESON BRINDISI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN ALICE MATTESON PA-C

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 IRVING ST NW STE 3150
WASHINGTON DC
20010-2934
US

IV. Provider business mailing address

106 IRVING ST NW STE 3150
WASHINGTON DC
20010-2934
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-5060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA031665
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: