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General NPI Number Information
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NPI Number | 1811631583
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Entity Type | Individual
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Provider Name | SARAH COLUMBIA MATTESON
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Gender | Female
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Dates
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Enumeration Date | 04/27/2022
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 969 W MAIN ST STE 2D
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City | WATERBURY
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State | CT
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Zip | 06708-2666
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Country | US
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Telephone | 203-754-0322
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Fax | 203-805-7175
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Provider Business Mailing Address
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Address Line | 969 W MAIN ST STE 2D
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City | WATERBURY
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State | CT
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Zip | 06708-2666
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Country | US
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Telephone | 203-754-0322
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Fax | 203-805-7175
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 10499
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 10499
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License Number State | CT
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