Provider Demographics
NPI:1114416153
Name:MANTHEY, NATHANIEL (RN)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:
Last Name:MANTHEY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5821 TIMBER TRL SE
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-2059
Mailing Address - Country:US
Mailing Address - Phone:952-500-0989
Mailing Address - Fax:
Practice Address - Street 1:3105 BLUEGRASS RD
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-3229
Practice Address - Country:US
Practice Address - Phone:952-500-0989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN227965-1163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine