Individual
ANDREA M MATTISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
3400 MARKET LN, KENOSHA, WI 53144-3430
(262) 551-4600
(262) 551-4630
Mailing address
3400 MARKET LN, KENOSHA, WI 53144-3430
(262) 551-4600
(262) 551-4630
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1391
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41928000
—
WI
Enumeration date
05/26/2006
Last updated
09/13/2016
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