Healthcare Provider Details

I. General information

NPI: 1497785026
Provider Name (Legal Business Name): JOSEPH GERARD MATTIS CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 FORBES AT MEYRAN AVENUE FORBES TOWER, SUITE 10028
PITTSBURGH PA
15213
US

IV. Provider business mailing address

600 FORBES AT MEYRAN AVENUE FORBES TOWER, SUITE 10028
PITTSBURGH PA
15213
US

V. Phone/Fax

Practice location:
  • Phone: 412-647-5954
  • Fax: 412-864-3400
Mailing address:
  • Phone: 412-647-5954
  • Fax: 412-864-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN310230L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberVP003361B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: