Healthcare Provider Details

I. General information

NPI: 1891482576
Provider Name (Legal Business Name): DARREN MICHAEL MATTERN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 04/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2891 FAIRWAY DRIVE
ALTOONA PA
16601
US

IV. Provider business mailing address

429 MANOR DR STE 10
EBENSBURG PA
15931-4917
US

V. Phone/Fax

Practice location:
  • Phone: 814-943-2273
  • Fax:
Mailing address:
  • Phone: 814-943-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN710222
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: