Doctor Name: | MRS. JULIE A MATTSON |
NPI Number: | 1265736995 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | IBCLC, RN |
License Number: | 2003006871 |
Business Practice Address: | 53 Highbush Ct Dardenne Prairie, MO - 633689765 |
Business Phone Number: | 3144206331 |
Business Fax Number: | |
Mailing Address: | 53 Highbush Ct, DARDENNE PRAIRIE |
State: | MO |
Postal Code: | 633689765 |
Phone Number: | 3144206331 |
Fax Number: | |
NPI Enumeration Date: | 01/10/2011 |
NPI Last Update Date: | 01/10/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WL0100X |
License Number: | 2003006871 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Lactation Consultant |
Taxonomy Definition: |