Individual
DR. SALLY S. MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2400 PINE RIDGE BLVD, WAUSAU, WI 54401-7803
(715) 847-2022
(715) 847-2775
Mailing address
8 N HILL RD, WAUSAU, WI 54403-3671
(715) 848-0196
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
28953
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30859700
—
WI
Enumeration date
08/11/2005
Last updated
01/28/2008
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