Healthcare Provider Details

I. General information

NPI: 1679482657
Provider Name (Legal Business Name): SUE MATHEWS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S WALL ST
COOS BAY OR
97420-3233
US

IV. Provider business mailing address

1554 MCPHERSON ST
NORTH BEND OR
97459-3625
US

V. Phone/Fax

Practice location:
  • Phone: 541-435-7218
  • Fax:
Mailing address:
  • Phone: 541-404-1887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201606428RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: