MEDICARE: DR. ANASTASIA LEIGH RALSTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209010136	IL

General Provider Information

NPI Number	:	1376889071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANASTASIA LEIGH RALSTON

Provider Business Mailing Address
First Line	:	1027 WASHINGTON AVE STE B
Second Line	:
City	:	VINCENNES
State	:	IN
Zip	:	47591-2240
Country	:	US
Telephone Number	:	618-554-0259
Fax Number	:

Provider Business Practice Location Address
First Line	:	1027 WASHINGTON AVE STE B
Second Line	:
City	:	VINCENNES
State	:	IN
Zip	:	47591-2240
Country	:	US
Telephone Number	:	812-494-7500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2012
Last Update Date	:	04/28/2023

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