Provider Demographics
NPI:1861419459
Name:MATSON, NORMAN (CRNA)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:MATSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 MARTINIQUE AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-7383
Mailing Address - Country:US
Mailing Address - Phone:541-484-1258
Mailing Address - Fax:541-484-4972
Practice Address - Street 1:920 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6024
Practice Address - Country:US
Practice Address - Phone:541-342-6699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR078040747367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR078040747OtherRN/CRNA
OR210992Medicaid
OR030482OtherAANA
ORR105193Medicare PIN
ORR134512Medicare PIN
OR210992Medicaid