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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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