Provider Demographics
NPI:1497181762
Name:BLAIR, CATHERINE (NP-C)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 RACINE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-8745
Mailing Address - Country:US
Mailing Address - Phone:910-399-6661
Mailing Address - Fax:
Practice Address - Street 1:265 RACINE DR STE 102
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8745
Practice Address - Country:US
Practice Address - Phone:910-399-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006568363LF0000X
NC217062363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1497181762Medicaid
SCNP3241Medicaid
NCNCF785CMedicare PIN
NC1497181762Medicaid
NCNCF785DMedicare PIN