Provider Demographics
NPI:1629681119
Name:MATTER, MORGAN NAN (RD, LD)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:NAN
Last Name:MATTER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 WALL ST
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55309-9445
Mailing Address - Country:US
Mailing Address - Phone:763-496-9784
Mailing Address - Fax:
Practice Address - Street 1:1900 CENTRACARE CIR STE 2400
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-4916
Practice Address - Fax:320-229-5174
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4355133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered