Provider Demographics
NPI:1992004352
Name:MATTERN, MADELINE FULCHER (NP)
Entity type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:FULCHER
Last Name:MATTERN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 NITTANY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:PA
Mailing Address - Zip Code:16841-4162
Mailing Address - Country:US
Mailing Address - Phone:814-383-2461
Mailing Address - Fax:814-865-3779
Practice Address - Street 1:2520 GREEN TECH DR
Practice Address - Street 2:SUITE D
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2300
Practice Address - Country:US
Practice Address - Phone:814-231-4043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007526363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily