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Individual

DR. NINA LOUISE MATTARELLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
2870 NE WEST DEVILS LAKE RD, LINCOLN CITY, OR 97367-5127
(541) 994-9191
(541) 994-9034
Mailing address
PO BOX 1194, CORVALLIS, OR 97339-1194

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301054688
MI
208000000X
Pediatrics Physician
Primary
MD185106
OR
208M00000X
Hospitalist Physician
4301054688
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1881786119
MI
01
3503334051
BCBS INDIVIDUAL PIN
MI
05
4796017
MI
Enumeration date
09/28/2006
Last updated
11/04/2020
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