Provider Demographics
NPI:1417395302
Name:MATTSON, NIRMALLA SINGH (CNP, CNS)
Entity Type:Individual
Prefix:MRS
First Name:NIRMALLA
Middle Name:SINGH
Last Name:MATTSON
Suffix:
Gender:F
Credentials:CNP, CNS
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:SINGH
Other - Last Name:MATTSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1700 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-273-4201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6861363LA2100X
MN2011012187364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6861OtherCERTIFIED NURSE PRACTITIONER
MN2011012187OtherCLINICAL NURSE SPECIALIST