Provider Demographics
NPI:1497908149
Name:BLAIR, SHARON M (RN)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:M
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 1:7640 PLEASANTVILLE WAY
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813
Mailing Address - Country:US
Mailing Address - Phone:760-380-7133
Mailing Address - Fax:
Practice Address - Street 1:7640 PLEASANTVILLE WAY
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813
Practice Address - Country:US
Practice Address - Phone:760-380-7133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001159686163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management