Provider Demographics
NPI:1962073619
Name:MATSON, NATHAN D (PA-C)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:D
Last Name:MATSON
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1630 PETERSBURG DR
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-5271
Mailing Address - Country:US
Mailing Address - Phone:208-970-1892
Mailing Address - Fax:
Practice Address - Street 1:2850 OLYMPUS DR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2271
Practice Address - Country:US
Practice Address - Phone:208-239-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-04
Last Update Date:2024-01-16
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant