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NPI Code Detail

MEDICARE: ANNE E MATTIS RN

MEDICARE: ANNE E MATTIS 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
1163WA0400XAddiction (Substance Use Disorder) Registered NurseOR

General Provider Information

NPI Number : 1518184662
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNE E MATTIS RN
Provider Business Mailing Address
First Line : 1000 SW VISTA AVE APT 1110
Second Line :
City : PORTLAND
State : OR
Zip : 97205-1168
Country : US
Telephone Number : 971-219-6131
Fax Number :
Provider Business Practice Location Address
First Line : 2600 SE BELMONT ST
Second Line :
City : PORTLAND
State : OR
Zip : 97214-2916
Country : US
Telephone Number : 503-239-5738
Fax Number : 503-239-8429
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2007
Last Update Date : 07/08/2007

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