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General NPI Number Information
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NPI Number | 1346154580
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Entity Type | Individual
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Provider Name | ELYSE MATTSON
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Gender | Female
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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Provider Practice Location Address
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Address Line | 67260 W CRYSTAL LAKE RD
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City | IRON RIVER
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State | WI
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Zip | 54847-4742
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Country | US
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Telephone | 218-393-6414
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Fax |
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Provider Business Mailing Address
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Address Line | 406 MCCALL DR
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City | JACKSONVILLE
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State | NC
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Zip | 28540-8076
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NULL
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