Provider Demographics
NPI:1467893701
Name:BLAIR, REBECCA L (CPNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:BLAIR
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:L
Other - Last Name:HAUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:17 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1930
Mailing Address - Country:US
Mailing Address - Phone:860-966-9901
Mailing Address - Fax:860-966-9901
Practice Address - Street 1:5 WALPOLE ST STE 2
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3351
Practice Address - Country:US
Practice Address - Phone:508-444-9818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY658448163W00000X
NC270864163W00000X
NC5007098363LP0200X
NYF382474363LP0200X
MARN2319505363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13393260OtherPHCS-MULTIPLAN
189N7OtherBCBS OF NC
NC254089OtherMEDCOST, LLC
NC1467893701OtherHEALTHSMART
NC1467893701OtherDOCTORS DIRECT
NC1467893701OtherHEALTHNET FEDERAL SERVICES
NC1510470OtherCOVENTRY OF THE CAROLINAS
NC0897955OtherCIGNA
NC1510470OtherWELLPATH
NC1467893701Medicaid
NC4457427OtherCOVENTRY NATIONAL - COVENTRY PPO
NC5566592OtherAETNA
FH4001875OtherFIRST CAROLINA CARE
NC1467893701OtherHUMANA
NC5194518OtherUNITED HEALTHCARE