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
Phone: (336) 716-2255
Fax:
Website:
Health care specialties
| Specialty | Code | License # | 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 14 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1700866431 | NPPES |
| North Carolina | MEDICAID | 7004065 | |
| North Carolina | Other | 194975 | |
| North Carolina | Other | 7046747 |
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