Provider Demographics
NPI:1861680241
Name:MATTILA, ALLISON MARIE (DNP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:MATTILA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PIER 1 STE 301
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-6338
Mailing Address - Country:US
Mailing Address - Phone:503-741-3570
Mailing Address - Fax:503-741-3569
Practice Address - Street 1:10 PIER 1 STE 301
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-6338
Practice Address - Country:US
Practice Address - Phone:503-741-3570
Practice Address - Fax:503-741-3569
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200750140NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
38-1852OtherFQHC MEDICARE
OR231893OtherFQHC MEDICAID
OR242060Medicaid