Healthcare Provider Details

I. General information

NPI: 1477277754
Provider Name (Legal Business Name): LAURA DIMATTIA AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N 39TH ST
PHILADELPHIA PA
19104-2640
US

IV. Provider business mailing address

51 N 39TH ST
PHILADELPHIA PA
19104-2640
US

V. Phone/Fax

Practice location:
  • Phone: 610-405-0168
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP024816
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: