Individual
MS. GINA RENAE MATHIASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
ALTRU CANCER CENTER, 960 S COLUMBIA ROAD, GRAND FORKS, ND 58201
(701) 780-5400
Mailing address
PO BOX 13780, GRAND FORKS, ND 58208
(701) 780-1891
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
201308
ND
363L00000X
Nurse Practitioner
RN239823
GA
Other
Enumeration date
10/28/2020
Last updated
01/07/2025
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