| Dr Nina Louise Mattarella, MD | |
|
2870 Ne West Devils Lake Rd, Lincoln City, OR 97367-5127 | |
| (541) 994-9191 | |
| (541) 994-9034 |
| Full Name | Dr Nina Louise Mattarella |
|---|---|
| Gender | Female |
| Speciality | Pediatrics |
| Location | 2870 Ne West Devils Lake Rd, Lincoln City, Oregon |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881786119 | NPI | - | NPPES |
| 3503334051 | Other | MI | BCBS INDIVIDUAL PIN |
| 4796017 | Medicaid | MI | |
| 1881786119 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 4301054688 (Michigan) | Secondary |
| 208M00000X | Hospitalist | 4301054688 (Michigan) | Secondary |
| 208000000X | Pediatrics | MD185106 (Oregon) | Primary |
| Entity Name | Northwest Medical Foundation Of Tillamook |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1871575225 PECOS PAC ID: 5092619569 Enrollment ID: O20031208000676 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Nina Louise Mattarella, MD Po Box 1194, Corvallis, OR 97339-1194 Ph: () - | Dr Nina Louise Mattarella, MD 2870 Ne West Devils Lake Rd, Lincoln City, OR 97367-5127 Ph: (541) 994-9191 |
Caitlyn Anglin, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 2870 Ne West Devils Lake Rd, Lincoln City, OR 97367 Phone: 541-994-9191 | |
Tori Leslie Smith, D.O. Pediatrics Medicare: Medicare Enrolled Practice Location: 2870 Ne West Devils Lake Rd, Lincoln City, OR 97367 Phone: 541-994-9191 |