Provider Demographics
NPI:1033511225
Name:BLAIR, ANGELA LYNN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LYNN
Last Name:BLAIR
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 E 9TH ST NORTH
Mailing Address - Street 2:BDLG 4970 RM 319
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314
Mailing Address - Country:US
Mailing Address - Phone:912-435-1327
Mailing Address - Fax:912-435-6151
Practice Address - Street 1:703 E 9TH ST NORTH
Practice Address - Street 2:BDLG 4970 RM 319
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314
Practice Address - Country:US
Practice Address - Phone:912-435-1327
Practice Address - Fax:912-435-6151
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN186218163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management