Provider Demographics
NPI:1669572566
Name:MATTICE, MARGARET R (MSN, APNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:R
Last Name:MATTICE
Suffix:
Gender:F
Credentials:MSN, APNP-BC
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Mailing Address - Street 1:888 THACKERAY TRL 103
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4342
Mailing Address - Country:US
Mailing Address - Phone:262-354-3744
Mailing Address - Fax:262-354-3748
Practice Address - Street 1:1145 W MAIN AVE
Practice Address - Street 2:STE. 205
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-1698
Practice Address - Country:US
Practice Address - Phone:920-336-6455
Practice Address - Fax:920-336-6646
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2749-33363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41268900Medicaid
WI41268900Medicaid
0084-00217Medicare ID - Type Unspecified