Provider Demographics
NPI:1134485329
Name:BLAIR, SUMMER ALIA (ANP-BC)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:ALIA
Last Name:BLAIR
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 S 3RD ST STE 210
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4206
Mailing Address - Country:US
Mailing Address - Phone:833-445-5998
Mailing Address - Fax:844-249-5579
Practice Address - Street 1:1250 LINDA ST
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1853
Practice Address - Country:US
Practice Address - Phone:440-250-3560
Practice Address - Fax:216-712-7066
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13164363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health