Basic Information
| Provider Information | |||||||||
| NPI: | 1407885486 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATTES | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | GHORMLEY | ||||||||
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| Credential: | CCP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1JARRET WHITE ROAD | ||||||||
| Address2: | TRIPLER ARMY MEDICAL CENTER ATTN: MCHK-QS | ||||||||
| City: | TRIPLER AMC | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968595001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084332460 | ||||||||
| FaxNumber: | 8084331558 | ||||||||
| Practice Location | |||||||||
| Address1: | 1JARRET WHITE ROAD | ||||||||
| Address2: | TRIPLER ARMY MEDICAL CENTER ATTN: MCHK-QS | ||||||||
| City: | TRIPLER AMC | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968595001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084332460 | ||||||||
| FaxNumber: | 8084331558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 2000160632 | MO | Y | Other Service Providers | Specialist |
No ID Information.