| NPI | 1043218951 |
|---|---|
| Former Name | MARTHA LYNN MATTESON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 180587) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: NY 180587) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2021-06-10 |