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Individual
JENNIFER L VAN MATRE-WATTLES
Active
Individual
JENNIFER L VAN MATRE-WATTLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
11873
WI
363L00000X
Nurse Practitioner
163519
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
11873
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100199781
—
WI
05
—
100199803
—
WI
Enumeration date
04/08/2022
Last updated
04/29/2025
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