Provider Demographics
NPI:1831715994
Name:RAPH, ALYSON (FNP)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:
Last Name:RAPH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ANNA PEARL SHERRICK HAL
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715
Mailing Address - Country:US
Mailing Address - Phone:406-994-3597
Mailing Address - Fax:
Practice Address - Street 1:1950 W ROOSEVELT HWY
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MT
Practice Address - Zip Code:59474-1549
Practice Address - Country:US
Practice Address - Phone:406-434-3100
Practice Address - Fax:406-434-3143
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT390200000X
MT240392363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program