Healthcare Provider Details

I. General information

NPI: 1194663377
Provider Name (Legal Business Name): CASSANDRA MARIE MATTESON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6544 BODAS RD
GILBERT MN
55741-8118
US

IV. Provider business mailing address

6544 BODAS RD
GILBERT MN
55741-8118
US

V. Phone/Fax

Practice location:
  • Phone: 715-338-9249
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13802
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: