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General NPI Number Information
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NPI Number | 1760710172
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Entity Type | Individual
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Provider Name | HARRIET JEAN MATTLIN NP
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Gender | Female
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Dates
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Enumeration Date | 11/23/2009
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1322 E MCANDREWS RD STE 202
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City | MEDFORD
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State | OR
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Zip | 97504-6177
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Country | US
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Telephone | 541-773-3688
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Fax | 541-773-3125
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Provider Business Mailing Address
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Address Line | 1322 E MCANDREWS RD SUITE 202
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City | MEDFORD
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State | OR
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Zip | 97504
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Country | US
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Telephone | 541-773-3688
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Fax | 541-773-3125
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 201400209RN
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 15398
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 15398
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201400210NP-PP
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License Number State | OR
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