Provider Demographics
NPI:1508339292
Name:BLAIS, CLAIR ANGELIQUE (RN)
Entity Type:Individual
Prefix:
First Name:CLAIR
Middle Name:ANGELIQUE
Last Name:BLAIS
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 1:22150 DELIGHTFUL WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-9196
Mailing Address - Country:US
Mailing Address - Phone:530-949-2986
Mailing Address - Fax:
Practice Address - Street 1:22150 DELIGHTFUL WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-9196
Practice Address - Country:US
Practice Address - Phone:530-949-2986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-06
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA606689163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics