Provider Demographics
NPI:1386662732
Name:BLAIR, DIANA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 S 5TH STREET
Mailing Address - Street 2:5TH FLOOR BILLING
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103
Mailing Address - Country:US
Mailing Address - Phone:610-778-9297
Mailing Address - Fax:610-778-9270
Practice Address - Street 1:850 S 5TH STREET
Practice Address - Street 2:GOOD SHEPHERD PHYSICIAN GROUP
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103
Practice Address - Country:US
Practice Address - Phone:610-776-3278
Practice Address - Fax:610-776-3326
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008866363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner