Provider Demographics
NPI:1225269095
Name:MATTICE, CONNIE RUTH (RN)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:RUTH
Last Name:MATTICE
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:7237 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-7758
Mailing Address - Country:US
Mailing Address - Phone:616-457-3143
Mailing Address - Fax:616-391-2927
Practice Address - Street 1:425 CHERRY ST. S.E
Practice Address - Street 2:PLANNED PARENTHOOD CENTERS OF WEST MICHIGAN
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-774-7005
Practice Address - Fax:616-774-0516
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI2088590363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner