KIMBERLY MATTINA NPI 1104231083

NPI Information

NPI: 1104231083
Provider Name: KIMBERLY MATTINA
Classification: Nurse Practitioner - 363LA2100X
Entity Type: Individual

Specialization: Acute Care

PECOS Registration: Yes

Address:
26206 W 12 MILE RD STE 105
SOUTHFIELD, MI
ZIP 48034
Phone: (248) 200-3715
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Kimberly Mattina is an acute care nurse practitioner in Southfield, MI with 5 years of experience. Kimberly Mattina NPI is 1104231083. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

26206 W 12 MILE RD STE 105
SOUTHFIELD, MI
ZIP 48034-799
Phone: (248) 200-3715

The NPI 1104231083 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/30/2014 and was last updated on 9/7/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2100X	Nurse Practitioner	Acute Care	4704306684	MICHIGAN	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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