MEDICARE: ALLISON MARIE MATTILA DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	200750140NP	OR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38-1852	OTHER		FQHC MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861680241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON MARIE MATTILA DNP

Provider Business Mailing Address
First Line	:	10 PIER 1 STE 301
Second Line	:
City	:	ASTORIA
State	:	OR
Zip	:	97103-6338
Country	:	US
Telephone Number	:	503-741-3570
Fax Number	:	503-741-3569

Provider Business Practice Location Address
First Line	:	10 PIER 1 STE 301
Second Line	:
City	:	ASTORIA
State	:	OR
Zip	:	97103-6338
Country	:	US
Telephone Number	:	503-741-3570
Fax Number	:	503-741-3569

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	07/07/2023

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Directions to “ ALLISON MARIE MATTILA DNP” Practice Location

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