Provider Demographics
NPI:1770771487
Name:MATTERN, MARGARET E (LPN)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:E
Last Name:MATTERN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 W 73RD ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-4041
Mailing Address - Country:US
Mailing Address - Phone:317-731-4049
Mailing Address - Fax:
Practice Address - Street 1:910 W 73RD ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-4041
Practice Address - Country:US
Practice Address - Phone:317-731-4049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27053855A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse