Provider Demographics
NPI:1518992320
Name:MATTSON, SUSAN ELIZABETH (NP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:MATTSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:76 PLEASANT STREET
Mailing Address - City:MARION
Mailing Address - State:MA
Mailing Address - Zip Code:02738-0002
Mailing Address - Country:US
Mailing Address - Phone:508-748-1445
Mailing Address - Fax:508-748-0461
Practice Address - Street 1:221 FITZGERALD DR
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-3426
Practice Address - Country:US
Practice Address - Phone:508-996-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA138353363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0701386Medicaid
MAS43059Medicare UPIN
MANPO764Medicare ID - Type Unspecified