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Individual
JENNA MARIE MATTOCKS
Active
Individual
JENNA MARIE MATTOCKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
CNP 4319
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1376909242
NPI
MN
01
—
2074717
RN LICENSE
MN
01
—
CNP 4319
CNP LICENSE
MN
Enumeration date
01/07/2016
Last updated
10/21/2024
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