Provider Demographics
NPI:1407993082
Name:BLAIR, MARCIA ANN (RN, CCM, CDMS)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:ANN
Last Name:BLAIR
Suffix:
Gender:F
Credentials:RN, CCM, CDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:SEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44273-9188
Mailing Address - Country:US
Mailing Address - Phone:330-904-9718
Mailing Address - Fax:330-769-0177
Practice Address - Street 1:40 W MAPLE DR
Practice Address - Street 2:
Practice Address - City:SEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44273-9188
Practice Address - Country:US
Practice Address - Phone:330-904-9718
Practice Address - Fax:330-769-0177
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-258085171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator