Healthcare Provider Details

I. General information

NPI: 1477472462
Provider Name (Legal Business Name): MATTHEW SCOTT NELSON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 BEAM AVE STE F
MAPLEWOOD MN
55109-1171
US

IV. Provider business mailing address

5854 212TH ST N
FOREST LAKE MN
55025-2105
US

V. Phone/Fax

Practice location:
  • Phone: 651-340-1445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number14319
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: