Individual provider · Type 1 NPI

Ibtisam Matta, RN

Child & Adolescent Psychiatric/Mental Health Registered Nurse · Grand Rapids, MI

NPI number 1063176543 Active

Practice location

790 Fuller Ave NE
Grand Rapids, MI 49503-1918

Mailing address

2610 Riley Ave SW
Wyoming, MI 49509-2016

Specialties and licenses

TaxonomyCodeLicense
Child & Adolescent Psychiatric/Mental Health Registered Nurse Primary 163WP0807X4704359386 (MI)

Child & Adolescent Psychiatric/Mental Health Registered Nurse: Definition to come...

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About NPI 1063176543

Ibtisam Matta, RN's National Provider Identifier is 1063176543, issued on Oct 29, 2021. The primary taxonomy on file is Child & Adolescent Psychiatric/Mental Health Registered Nurse (163WP0807X), and the practice location is in Grand Rapids, MI. The record was last updated on Oct 29, 2021.