Provider Demographics
NPI:1902927965
Name:MATTERN, ALISON J (RN,CNR)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:J
Last Name:MATTERN
Suffix:
Gender:F
Credentials:RN,CNR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-3819
Mailing Address - Country:US
Mailing Address - Phone:574-533-0560
Mailing Address - Fax:574-533-1716
Practice Address - Street 1:1122 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-3819
Practice Address - Country:US
Practice Address - Phone:574-533-0560
Practice Address - Fax:574-533-1716
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000397A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200506790Medicaid
INP73992Medicare UPIN
IN200506790Medicaid