Healthcare Provider Details

I. General information

NPI: 1881528701
Provider Name (Legal Business Name): MATTHEW GARRETT MOBLEY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 E 4TH ST
DULUTH MN
55805-2147
US

IV. Provider business mailing address

810 E 4TH ST
DULUTH MN
55805-2147
US

V. Phone/Fax

Practice location:
  • Phone: 218-730-2352
  • Fax: 218-728-7923
Mailing address:
  • Phone: 218-730-2352
  • Fax: 218-728-7923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2477230
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: