Healthcare Provider Details

I. General information

NPI: 1619829520
Provider Name (Legal Business Name): KELLY MATTAR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CINDIS WAY
BRIDGEWATER MA
02324-1765
US

IV. Provider business mailing address

45 CINDIS WAY
BRIDGEWATER MA
02324-1765
US

V. Phone/Fax

Practice location:
  • Phone: 781-261-4638
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN257451
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: