Mattice, Mark R.

Mattice, Mark R. is an individual health care provider with primary practice located at Medical Center Blvd , Winston Salem NC 27157-0001. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as his primary health care specialty. Mattice, Mark R. can be contacted via phone (336) 716-2255.

Contact Information

Primary practice address
Medical Center Blvd Winston Salem NC 27157-0001
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 200883 North Carolina

Profile Details

NPI number 1700866431
LBN Legal business name Mattice, Mark R.
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 19th, 2006
Last updated Aug 16th, 2012 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700866431 NPPES
North Carolina MEDICAID 7004065
North Carolina Other 194975
North Carolina Other 7046747

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