Provider Demographics
NPI:1891507216
Name:MATTOCKS, AMY DIANNE (RN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DIANNE
Last Name:MATTOCKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 SE VIEWMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-1968
Mailing Address - Country:US
Mailing Address - Phone:541-766-3546
Mailing Address - Fax:541-766-6143
Practice Address - Street 1:121 SE VIEWMONT AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-1968
Practice Address - Country:US
Practice Address - Phone:541-766-3546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201604826RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse