Provider Demographics
NPI:1407907033
Name:HALL, ALISON M (PA-C)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:M
Last Name:HALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 CHARLOTTE ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-2741
Mailing Address - Country:US
Mailing Address - Phone:406-625-3058
Mailing Address - Fax:406-578-3602
Practice Address - Street 1:2135 CHARLOTTE ST STE 1A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-2741
Practice Address - Country:US
Practice Address - Phone:406-625-3058
Practice Address - Fax:406-578-3602
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000916363A00000X
MTMED-PAC-LIC-129466363AM0700X
VT055.0031160363AM0700X
AZ9022363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1407907033OtherNPI
CA970002283Medicare PIN
CT1407907033OtherNPI