Provider Demographics
NPI:1235376609
Name:BLAIR, TRACI GAE (RN,)
Entity Type:Individual
Prefix:MS
First Name:TRACI
Middle Name:GAE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:RN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5232 SARATOGA CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2296
Mailing Address - Country:US
Mailing Address - Phone:505-250-8822
Mailing Address - Fax:
Practice Address - Street 1:5232 SARATOGA CT NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2296
Practice Address - Country:US
Practice Address - Phone:505-250-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR42597282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital