DOROTHY L MATTISE

BOISE, ID
NPI1457306870
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy367500000X Nurse Anesthetist, Certified Registered
(Licence: ID  RNA120)
Additional Taxonomies163W00000X Registered Nurse
(Licence: ID  N7765)
Enumeration Date2006-05-24
Last Update Date2011-04-07
Business Address
-- DOROTHY L MATTISE CRNA
1055 N CURTIS RD
BOISE, ID 83706-1352
Phone number: 208-367-6416
Mailing Address
-- DOROTHY L MATTISE CRNA
PO BOX 4268
PORTLAND, OR 97208-4268
Phone number: 503-372-2740