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Individual

PATTY JO MATTOX

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
C.R.N.P.

Contact information

Practice address
4940 EASTERN AVE, BALTIMORE, MD 21224-2735
(410) 550-5633
Mailing address
PO BOX 64264, BALTIMORE, MD 21264-4264
(410) 933-4397

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R146293
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
718000400
MD
Enumeration date
05/08/2006
Last updated
01/25/2013
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