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Individual
MR. TREVOR SAMUEL MATTARELLA
Active
Individual
MR. TREVOR SAMUEL MATTARELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704285057
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704285057
STATE LICENSE
MI
Enumeration date
10/16/2017
Last updated
03/26/2021
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