Provider Demographics
NPI:1326723545
Name:MATTSON, KRISTEN ELAINE (BSN, RN, SRNA)
Entity Type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:ELAINE
Last Name:MATTSON
Suffix:
Gender:F
Credentials:BSN, RN, SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62245-2039
Mailing Address - Country:US
Mailing Address - Phone:618-772-9585
Mailing Address - Fax:
Practice Address - Street 1:SIUE ALUMNI HALL
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62026-0001
Practice Address - Country:US
Practice Address - Phone:618-650-3705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program