Healthcare Provider Details

I. General information

NPI: 1346420692
Provider Name (Legal Business Name): MARY E ALSTON ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2007
Last Update Date: 08/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MARSH ST
MANKATO MN
56001-4752
US

IV. Provider business mailing address

915 HIGHLAND BLVD
BOZEMAN MT
59715-6902
US

V. Phone/Fax

Practice location:
  • Phone: 507-385-6337
  • Fax: 507-385-6497
Mailing address:
  • Phone: 406-414-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License NumberR 145433-8
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13722
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR145433-84
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: