Individual
BRYAN P MATHIESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
11141 PARKVIEW PLAZA DR STE 305, FORT WAYNE, IN 46845-1715
(260) 266-8900
(260) 266-8935
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71002603A
IN
363L00000X
Nurse Practitioner
78183
ID
363L00000X
Nurse Practitioner
8890
WI
363LF0000X
Family Nurse Practitioner
0024192011
VA
363LF0000X
Family Nurse Practitioner
2015002005
MO
363LF0000X
Family Nurse Practitioner
26537
TN
363LF0000X
Family Nurse Practitioner
4704427019
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000584893
ANTHEM
IN
05
—
200889510
—
IN
05
—
3124112
—
OH
Enumeration date
09/20/2007
Last updated
12/17/2025
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