Most Relevant Information
Provider Data
| NPI Number: | 1003683509 |
| Provider Name: | KATHERINE MATTINEN PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 14744 |
Most Important Dates
| Enumeration Date: | 12/05/2023 |
| Last Updated: | 12/05/2023 |
Provider Practice Location
5109 36TH AVE N
CRYSTAL
MN
554222007
Practice Location Phone/Fax
| Phone: | 7635877999 |
| Fax: |
Provider Mailing Location
601 SE MAIN ST APT 202
MINNEAPOLIS
MN
554142953
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |