Provider Demographics
NPI:1912503921
Name:ARLT, ALLYSON LEIGH (CNA, MED AID)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:LEIGH
Last Name:ARLT
Suffix:
Gender:F
Credentials:CNA, MED AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 FOOTHILLS RD SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-7093
Mailing Address - Country:US
Mailing Address - Phone:701-240-0576
Mailing Address - Fax:
Practice Address - Street 1:1609 FOOTHILLS RD SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-7093
Practice Address - Country:US
Practice Address - Phone:701-240-0576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND376K00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1456551Medicaid