Provider Demographics
NPI:1669543039
Name:CHARMAN, ALISON B (NP)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:B
Last Name:CHARMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0012
Mailing Address - Country:US
Mailing Address - Phone:509-824-1284
Mailing Address - Fax:406-327-1974
Practice Address - Street 1:500 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4008
Practice Address - Country:US
Practice Address - Phone:406-327-1940
Practice Address - Fax:406-327-1974
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN23933207Q00000X
MTNUR-APRN-LIC-100305363LA2200X
MTRN023933363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT27D0411341OtherCLIA ID#--LAB CERT
MTCI2709OtherRAILROAD MEDICARE GRP ID#
MT1104882232OtherGLACIER MEDICAL ASSOC NPI
MT000008287OtherMEDICARE PART B GRP ID#
MT810350909OtherFEIN
MTRN23933OtherMONTANA SATE LICENSE
MT000371341OtherBLUE CROSS/SHIELD PIN#
S63406Medicare UPIN
MTP00436734Medicare PIN
MT000371341OtherBLUE CROSS/SHIELD PIN#
MT1104882232OtherGLACIER MEDICAL ASSOC NPI