Individual
MOLLEEN M DEMATTEO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
214 ELMIRA RD, ITHACA, NY 14850-5302
(607) 273-9015
Mailing address
101 CEDAR LN, GROTON, NY 13073-1311
(607) 898-4703
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
506075
NY
Other
Enumeration date
09/06/2012
Last updated
09/06/2012
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