Healthcare Provider Details

I. General information

NPI: 1760506695
Provider Name (Legal Business Name): MARIE ANNETTE MATTEI-WEILAND APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 PROSSER RD
LAWRENCEBURG TN
38464-4233
US

IV. Provider business mailing address

184 PROSSER RD
LAWRENCEBURG TN
38464-4233
US

V. Phone/Fax

Practice location:
  • Phone: 931-762-1800
  • Fax: 931-762-9155
Mailing address:
  • Phone: 931-762-1800
  • Fax: 931-762-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN0000155633
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15306
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: