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NPI Code Detail

MEDICARE: ANNA MATTISON BS

MEDICARE: ANNA MATTISON BS
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1770912529
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA MATTISON BS
Provider Business Mailing Address
First Line : 7 COURT STREET
Second Line :
City : RUTLAND
State : VT
Zip : 05701-4594
Country : US
Telephone Number : 802-775-4388
Fax Number :
Provider Business Practice Location Address
First Line : 78 S MAIN ST
Second Line :
City : RUTLAND
State : VT
Zip : 05701-4594
Country : US
Telephone Number : 802-775-4388
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2013
Last Update Date : 12/02/2024

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