Individual
LYNNETTE M MATTESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
611 E MAIN STREET, SUITE 110, PETERSBURG, IN 47567-1270
(812) 354-8426
(812) 354-9134
Mailing address
611 E MAIN ST, SUITE 110, PETERSBURG, IN 47567-1270
(812) 354-8426
(812) 354-9134
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71005820A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000984156
ANTHEM
IN
05
—
201322180
—
IN
Enumeration date
09/23/2015
Last updated
08/15/2016
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