Active NPI
Debra Lynn Mattoon, LPN
- Licensed Practical Nurse
- Medina, NY
National Provider Identifier
1083919112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 300437
- Practice address
- 207 South Ave
Medina, NY 14103-1541 - Phone
- (585) 590-6859
- NPI assigned
- Jan 20, 2011
- Last updated
- Jan 20, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 300437 | NY | Primary |
Addresses
Primary practice location
207 South Ave
Medina, NY 14103-1541
Mailing address
207 South Ave
Medina, NY 14103-1541
Phone (585) 590-6859
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 300437 | NY | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1295481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295481600000",
"number": "1083919112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "207 SOUTH AVE",
"city": "MEDINA",
"state": "NY",
"postal_code": "141031541",
"telephone_number": "585-590-6859"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "207 SOUTH AVE",
"city": "MEDINA",
"state": "NY",
"postal_code": "141031541",
"telephone_number": "585-590-6859"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATTOON",
"first_name": "DEBRA",
"middle_name": "LYNN",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-01-20",
"last_updated": "2011-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "300437",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medina, NY
- Lpec Medical Eye Care PLLC (Lake Plains Eye Center)
- Lpec Medical Eyecare PLLC (Lake Plains Eye Center)
- Mary Elizabeth Luhr Johnson, CRNA
- Thomas J Madejski, MD
- Cindy Michelle Marzan, LPN
- Richard F Matuszak, RD, LD
- Amanda Ann McDonald, RN FNP
- Derrick Laird McGaughey, L.S.P., C.C.C.
- Kelly Deann McMurray, LPN
- Medina Central School District
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.