Healthcare Provider Details

I. General information

NPI: 1992634166
Provider Name (Legal Business Name): MATTHEW SLATON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 S MAIN ST
UKIAH CA
95482-4985
US

IV. Provider business mailing address

643 S MAIN ST
UKIAH CA
95482-4985
US

V. Phone/Fax

Practice location:
  • Phone: 707-380-5080
  • Fax:
Mailing address:
  • Phone: 707-380-5080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95248015
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: