Provider Demographics
NPI:1134496300
Name:BLAIR, ELISA M (RN, BSN)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:M
Last Name:BLAIR
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 N MESA ST
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-2108
Mailing Address - Country:US
Mailing Address - Phone:970-210-3767
Mailing Address - Fax:
Practice Address - Street 1:308 N MESA ST
Practice Address - Street 2:
Practice Address - City:FRUITA
Practice Address - State:CO
Practice Address - Zip Code:81521-2108
Practice Address - Country:US
Practice Address - Phone:970-210-3767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO180531163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management