Individual
JENNIFER S MATTINGLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
49557
WI
207RP1001X
Pulmonary Disease Physician
Primary
49557
WI
207RP1001X
Pulmonary Disease Physician
51195
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
MN
01
—
P00728930
MEDICARE RAILROAD
MN
Enumeration date
08/20/2006
Last updated
08/06/2014
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