Provider Demographics
NPI:1568917540
Name:BLAIR, SLOANE (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:SLOANE
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2299 BACON ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2299 BACON ST
Practice Address - Street 2:SUITE 7
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2050
Practice Address - Country:US
Practice Address - Phone:925-676-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY641058-1163W00000X
NYF382574-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse