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NPI Code Detail

MEDICARE: JAMIE MATTA RN, BSN

MEDICARE: JAMIE MATTA RN, BSN
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
1163WS0200XSchool Registered NurseRN121986LA

General Provider Information

NPI Number : 1316683709
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE MATTA RN, BSN
Provider Business Mailing Address
First Line : 146 REIHER RD
Second Line :
City : MANDEVILLE
State : LA
Zip : 70471-7261
Country : US
Telephone Number : 985-264-3875
Fax Number :
Provider Business Practice Location Address
First Line : 321 N THEARD ST
Second Line :
City : COVINGTON
State : LA
Zip : 70433-2835
Country : US
Telephone Number : 985-892-2276
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2022
Last Update Date : 05/09/2022

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