=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023848769
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALANA MARIE MASTIN CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2024
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 677 CATHEDRAL DR
-----------------------------------------------------
City | RAPID CITY
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57701-6018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-755-4150
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6312 W ELMWOOD DR
-----------------------------------------------------
City | BLACK HAWK
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57718-9762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-515-3436
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | CP003331
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------