Provider Demographics
NPI:1558701672
Name:RUSSO, ALLISON G (DNP, PMHNP- BC)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:G
Last Name:RUSSO
Suffix:
Gender:F
Credentials:DNP, PMHNP- BC
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3009 EARLY BIRD DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-5670
Mailing Address - Country:US
Mailing Address - Phone:406-389-5286
Mailing Address - Fax:
Practice Address - Street 1:3009 EARLY BIRD DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5670
Practice Address - Country:US
Practice Address - Phone:406-389-5286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC 38936363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health