Healthcare Provider Details

I. General information

NPI: 1922986348
Provider Name (Legal Business Name): COURTNEY ELIZABETH MATHIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 EMERSON AVE E
WEST ST PAUL MN
55118-2535
US

IV. Provider business mailing address

8360 LOWER 138TH CT
APPLE VALLEY MN
55124-9415
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-1800
  • Fax: 651-241-1826
Mailing address:
  • Phone: 651-895-3637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14618
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2466287
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: