Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ibtisam Matta, RN

Individual provider Child & Adolescent Psychiatric/Mental Health Registered Nurse · NPI 1063176543

Ibtisam Matta, RN is a Child & Adolescent Psychiatric/Mental Health Registered Nurse in Grand Rapids, Michigan. Licensed in Michigan. Registered with an NPI since 2021.

Licensed in
MI
In the registry since
2021
What do these letters mean?
RN — Registered Nurse
A licensed nurse who completed a nursing degree and passed the NCLEX-RN examination.

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Practice location Address checks out

790 Fuller Ave NE
Grand Rapids, MI 49503-1918
Phone: (616) 336-3765
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Child & Adolescent Psychiatric/Mental Health Registered Nurse (primary) Taxonomy 163WP0807X · Licence 4704359386 (MI)

Record details

NPI number1063176543
Entity typeIndividual (Type 1)
GenderFemale
Credentials RN
Sole proprietorNo
NPI enumeratedOctober 29, 2021
Last updated in NPPESOctober 29, 2021
Certification dateOctober 29, 2021
Mailing address2610 Riley Ave Sw, Wyoming, MI 49509-2016

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