Provider Demographics
NPI:1083446686
Name:MATHESON, ELLEN DOUGLAS (FNP-C)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:DOUGLAS
Last Name:MATHESON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-3448
Mailing Address - Country:US
Mailing Address - Phone:774-473-7869
Mailing Address - Fax:
Practice Address - Street 1:237 STATE RD
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-2612
Practice Address - Country:US
Practice Address - Phone:508-717-8903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2310705363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner