| Doctor Name: | ANGELA MATHISON |
| NPI Number: | 1083969778 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | G0712002 |
| Business Practice Address: | 14181 Business Center Dr Nw Elk River, MN - 553304654 |
| Business Phone Number: | 7632360500 |
| Business Fax Number: | 7632360525 |
| Mailing Address: | 14181 Business Center Dr Nw, ELK RIVER |
| State: | MN |
| Postal Code: | 553304654 |
| Phone Number: | 7632360500 |
| Fax Number: | 7632360525 |
| NPI Enumeration Date: | 07/18/2012 |
| NPI Last Update Date: | 07/18/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | G0712002 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |