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1063176543
IBTISAM MATTA
GRAND RAPIDS, MI
NPI
1063176543
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent
(Licence: MI 4704359386)
Enumeration Date
2021-10-29
Last Update Date
2021-10-29
Business Address
IBTISAM MATTA RN
790 FULLER AVE NE
GRAND RAPIDS, MI 49503-1918
Phone number: 616-336-3765
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Mailing Address
IBTISAM MATTA RN
2610 RILEY AVE SW
WYOMING, MI 49509-2016
Phone number: 517-331-3895
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