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General NPI Number Information
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NPI Number | 1912626508
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Entity Type | Individual
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Provider Name | LISA MATTERN APRN
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Gender | Female
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Dates
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Enumeration Date | 08/25/2022
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 116 MONTOWESE ST
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City | BRANFORD
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State | CT
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Zip | 06405-3871
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Country | US
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Telephone | 203-654-6915
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Fax |
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Provider Business Mailing Address
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Address Line | 170 MUNGERTOWN RD
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City | MADISON
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State | CT
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Zip | 06443-2259
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Country | US
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Telephone | 203-654-6915
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 10883
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License Number State | CT
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