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IBTISAM MATTA RN
NPI 1063176543
Registered Nurse - Psychiatric/Mental Health, Child & Adolescent in Grand Rapids, MI

Active since October 29, 2021
790 FULLER AVE NE, GRAND RAPIDS, MI 49503(616) 336-3765 Get Directions Write a Review

NPPES record last updated: October 29, 2021. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Ibtisam Matta Rn NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IBTISAM MATTA RN (NPI 1063176543) is an individual psychiatric/mental health, child & adolescent provider in Grand Rapids, Michigan, licensed in Michigan (4704359386) and active in the NPI registry since October 2021.

NPPES Registry Identity

NPI1063176543
Entity TypeIndividualFemale
Primary Taxonomy163WP0807X
Provider Legal NameIBTISAM MATTACredential: RN
Location Address790 FULLER AVE NEGrand Rapids, MI 49503-1918
Mailing Address2610 Riley Ave SwWyoming, MI 49509-2016 · (517) 331-3895
Phone(616) 336-3765
Sole ProprietorNo
Enumeration DateOctober 29, 2021
NPPES CertifiedOctober 29, 2021
✔ NPI 1063176543 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyRegistered Nurse · Psychiatric/Mental Health, Child & AdolescentNursing Service Providers
Taxonomy Code163WP0807X
License✔ Licensed in MI · 4704359386
790 FULLER AVE NE, Grand Rapids, MI 49503
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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DIANA DUARTE-MENENDEZ LMSW
Social Worker (Clinical)
790 FULLER AVE NE
GRAND RAPIDS, MI 49503
Kent County (616) 336-3909
MISS JALISA SHAWTAE SMITH LLMSW
Case Manager/Care Coordinator
790 FULLER AVE NE
GRAND RAPIDS, MI 49503
Kent County (616) 336-3909
MACKENZIE ERIN CLEGG
Behavior Analyst
790 FULLER AVE NE
GRAND RAPIDS, MI 49503
Kent County (616) 336-3909
MRS. ALEITA A BROWN LLBSW
Case Manager/Care Coordinator
790 FULLER AVE NE
GRAND RAPIDS, MI 49503
Kent County (616) 825-5412
ANNIKA KNOTT LMSW
Social Worker (Clinical)
790 FULLER AVE NE
GRAND RAPIDS, MI 49503
Kent County (616) 724-6942
VIOLET RAMAGE
Case Manager/Care Coordinator
790 FULLER AVE NE
GRAND RAPIDS, MI 49503
Kent County (734) 493-2978
DAVID G MARSHALL LPC
Counselor (Professional)
790 FULLER AVE NE
GRAND RAPIDS, MI 49503
Kent County (616) 336-3909
DAWN MARIE MACDONALD LLMSW
Social Worker
790 FULLER AVE NE
GRAND RAPIDS, MI 49503
Kent County (616) 336-3909

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ibtisam Matta's NPI number?

The NPI number for Ibtisam Matta is 1063176543. It was assigned to this individual provider in the NPPES registry on October 29, 2021.

Where is Ibtisam Matta located?

Ibtisam Matta practices at 790 Fuller Ave NE, Grand Rapids, MI 49503. The listed phone number is (616) 336-3765.

What is Ibtisam Matta's specialty?

The primary specialty registered for this NPI is Registered Nurse, specializing in Psychiatric/Mental Health, Child & Adolescent, with taxonomy code 163WP0807X.

When was this NPI record last updated?

The NPPES record for Ibtisam Matta was last updated on October 29, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.