Provider Demographics
NPI:1932913670
Name:MATTOCKS, NORMA JEAN (NP)
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:JEAN
Last Name:MATTOCKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:JEAN
Other - Last Name:WESNESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 IVY ST STE 206
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-1627
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:607-271-2071
Practice Address - Street 1:100 JOHN ROEMMELT DR STE 204
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8304
Practice Address - Country:US
Practice Address - Phone:607-795-2828
Practice Address - Fax:607-795-2829
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY355989363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily