Provider Demographics
NPI:1346420692
Name:ALSTON, MARY E (ANP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:ALSTON
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6902
Mailing Address - Country:US
Mailing Address - Phone:406-414-1044
Mailing Address - Fax:
Practice Address - Street 1:1025 MARSH ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4752
Practice Address - Country:US
Practice Address - Phone:507-385-6337
Practice Address - Fax:507-385-6497
Is Sole Proprietor?:No
Enumeration Date:2007-11-04
Last Update Date:2015-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 145433-8374T00000X
MT13722163W00000X
MTR145433-84363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No163W00000XNursing Service ProvidersRegistered Nurse