Provider Demographics
NPI:1093129603
Name:BLAIR, JANICE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:LPN
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 207
Mailing Address - Street 2:
Mailing Address - City:CHERRY CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:14723-0207
Mailing Address - Country:US
Mailing Address - Phone:716-296-5029
Mailing Address - Fax:
Practice Address - Street 1:500 PINE ST
Practice Address - Street 2:SUITE 15
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5384
Practice Address - Country:US
Practice Address - Phone:716-487-2273
Practice Address - Fax:716-484-9584
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126687-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse