MEDICARE: JADE MATTERN MSN, AGACNP-BC

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	363L00000X	Nurse Practitioner	AP7630	AZ
2	363LA2100X	Acute Care Nurse Practitioner	AP7630	AZ
3	363LG0600X	Gerontology Nurse Practitioner	AP7630	AZ

General Provider Information

NPI Number	:	1326435439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADE MATTERN MSN, AGACNP-BC

Provider Business Mailing Address
First Line	:	21321 E OCOTILLO RD
Second Line	:	SUITE #M131
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-5996
Country	:	US
Telephone Number	:	480-636-1225
Fax Number	:	480-636-8890

Provider Business Practice Location Address
First Line	:	21321 E OCOTILLO RD
Second Line	:	SUITE #M131
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-5996
Country	:	US
Telephone Number	:	480-636-1225
Fax Number	:	480-636-8890

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

Provider Enumeration Date	:	04/16/2015
Last Update Date	:	12/08/2025

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