Healthcare Provider Details

I. General information

NPI: 1639225006
Provider Name (Legal Business Name): ELIZABETH ANNE HUBBARD MATTSON ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1232 UNIVERSITY OF OREGON HEALTH CENTER
EUGENE OR
97403-1232
US

IV. Provider business mailing address

1232 UNIVERSITY OF OREGON HEALTH CENTER
EUGENE OR
97403-1232
US

V. Phone/Fax

Practice location:
  • Phone: 541-346-2760
  • Fax:
Mailing address:
  • Phone: 541-346-2760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number092006849N3ANP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: