Healthcare Provider Details

I. General information

NPI: 1306134309
Provider Name (Legal Business Name): JAIME RAE MATTSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 W 11TH ST
GRAFTON ND
58237-2138
US

IV. Provider business mailing address

1458 WESTERN AVE
GRAFTON ND
58237-1879
US

V. Phone/Fax

Practice location:
  • Phone: 701-352-4059
  • Fax: 701-352-9290
Mailing address:
  • Phone: 701-360-0697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR30910
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: