Provider Demographics
NPI:1104219351
Name:BLAIR, HEATHER (APN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 TANGLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SILVERTHORNE
Mailing Address - State:CO
Mailing Address - Zip Code:80498-5314
Mailing Address - Country:US
Mailing Address - Phone:970-468-1003
Mailing Address - Fax:970-262-2196
Practice Address - Street 1:265 TANGLEWOOD LN
Practice Address - Street 2:
Practice Address - City:SILVERTHORNE
Practice Address - State:CO
Practice Address - Zip Code:80498-5314
Practice Address - Country:US
Practice Address - Phone:970-468-1003
Practice Address - Fax:970-262-2196
Is Sole Proprietor?:No
Enumeration Date:2015-03-12
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991866-NP363LP2300X
CO0991866363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19382804Medicaid
CO436423YVBWMedicare UPIN