Provider Demographics
NPI:1154785202
Name:BLUST, ALLISON KATE
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:KATE
Last Name:BLUST
Suffix:
Gender:F
Credentials:
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 1248
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-1248
Mailing Address - Country:US
Mailing Address - Phone:831-277-3124
Mailing Address - Fax:
Practice Address - Street 1:270 COUNTY HOSPITAL RD STE 109
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9173
Practice Address - Country:US
Practice Address - Phone:530-283-6307
Practice Address - Fax:530-757-7898
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95089051163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse