MEDICARE: DONNA MARIA MATTICKS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist
2	163WC1500X	Community Health Registered Nurse		IL

General Provider Information

NPI Number	:	1134321581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA MARIA MATTICKS RN

Provider Business Mailing Address
First Line	:	6309 WIND TREE RD
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62712-3738
Country	:	US
Telephone Number	:	217-899-7524
Fax Number	:	217-529-9514

Provider Business Practice Location Address
First Line	:	6309 WIND TREE RD
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62712-3738
Country	:	US
Telephone Number	:	217-899-7524
Fax Number	:	217-529-9514

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	09/11/2025

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