Healthcare Provider Details

I. General information

NPI: 1780518902
Provider Name (Legal Business Name): NATHAN JORDAN MATTHEWS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 1ST ST SW
ROCHESTER MN
55905-0002
US

IV. Provider business mailing address

93 GRANDE ISLE AVE SW UNIT 2512
ROCHESTER MN
55902-3545
US

V. Phone/Fax

Practice location:
  • Phone: 480-301-8000
  • Fax:
Mailing address:
  • Phone: 515-509-5773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number2476099
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: