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General NPI Number Information
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NPI Number | 1790513091
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Entity Type | Individual
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Provider Name | ALLISON LAUREL MATAVA CRNP
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Gender | Female
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Dates
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Enumeration Date | 07/26/2024
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 1265 WAYNE AVE STE 103
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City | INDIANA
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State | PA
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Zip | 15701-3501
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Country | US
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Telephone | 724-463-1048
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Fax | 724-463-1049
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Provider Business Mailing Address
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Address Line | 1265 WAYNE AVE STE 103
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City | INDIANA
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State | PA
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Zip | 15701-3501
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Country | US
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Telephone | 859-475-1920
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Fax | 877-712-2112
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | SP030200
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License Number State | PA
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