Individual
KATIE ANN MATTILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
790 FULLER AVE NE, GRAND RAPIDS, MI 49503-1918
(616) 336-3909
(616) 336-8830
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
11177
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
204623
ND
Other
Enumeration date
11/03/2023
Last updated
05/29/2026
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