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General NPI Number Information
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NPI Number | 1962930180
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Entity Type | Individual
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Provider Name | ANGELA MARIE MATTERN NP
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Gender | Female
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Dates
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Enumeration Date | 06/01/2017
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 60101 BODNAR BLVD STE 100B
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City | MISHAWAKA
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State | IN
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Zip | 46544-9340
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Country | US
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Telephone | 574-335-8800
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Fax | 574-335-0613
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Provider Business Mailing Address
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Address Line | 5215 HOLY CROSS PKWY PROVIDER SERVICES-ENROLLMENT
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City | MISHAWAKA
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State | IN
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Zip | 46545-1469
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71007221A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71007221A
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License Number State | IN
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