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General NPI Number Information
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NPI Number | 1669572566
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Entity Type | Individual
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Provider Name | MARGARET R MATTICE MSN, APNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 12/16/2015
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Provider Practice Location Address
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Address Line | 1145 W MAIN AVE STE. 205
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City | DE PERE
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State | WI
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Zip | 54115-1698
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Country | US
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Telephone | 920-336-6455
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Fax | 920-336-6646
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Provider Business Mailing Address
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Address Line | 888 THACKERAY TRL 103
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City | OCONOMOWOC
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State | WI
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Zip | 53066-4342
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Country | US
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Telephone | 262-354-3744
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Fax | 262-354-3748
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2749-33
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License Number State | WI
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