Provider Demographics
NPI:1790513091
Name:MATAVA, ALLISON LAUREL (CRNP)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:LAUREL
Last Name:MATAVA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 HILLS PLZ STE 530
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-4220
Mailing Address - Country:US
Mailing Address - Phone:814-419-8084
Mailing Address - Fax:
Practice Address - Street 1:881 HILLS PLZ STE 530
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4220
Practice Address - Country:US
Practice Address - Phone:814-419-8084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030200363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care