Provider Demographics
NPI:1629885090
Name:MATTOCKS-WASHINGTON, CAPRESHA
Entity type:Individual
Prefix:
First Name:CAPRESHA
Middle Name:
Last Name:MATTOCKS-WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 S GLENBURNIE RD STE M
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2632
Mailing Address - Country:US
Mailing Address - Phone:252-229-4201
Mailing Address - Fax:
Practice Address - Street 1:1505 S GLENBURNIE RD STE M
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2632
Practice Address - Country:US
Practice Address - Phone:252-229-4201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29197494172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver