Healthcare Provider Details

I. General information

NPI: 1770458713
Provider Name (Legal Business Name): ALISON MARY BLAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 ALPENGLOW LN
LIVINGSTON MT
59047-8506
US

IV. Provider business mailing address

PO BOX 493
MC ALLISTER MT
59740-0493
US

V. Phone/Fax

Practice location:
  • Phone: 406-222-3541
  • Fax:
Mailing address:
  • Phone: 831-673-0149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number218912
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: