Healthcare Provider Details

I. General information

NPI: 1174200356
Provider Name (Legal Business Name): NATHAN WILLIAM KORANDA DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 METRO BLVD STE 400
EDINA MN
55439-2307
US

IV. Provider business mailing address

5123 W 98TH ST # 2110
MINNEAPOLIS MN
55437-2040
US

V. Phone/Fax

Practice location:
  • Phone: 612-230-0465
  • Fax: 763-334-5806
Mailing address:
  • Phone: 630-854-6601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10393
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: