Provider Demographics
NPI:1598118150
Name:BLAIR, MARIAH WHISENHUNT (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:WHISENHUNT
Last Name:BLAIR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9421 BARTONS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-9707
Mailing Address - Country:US
Mailing Address - Phone:336-266-8547
Mailing Address - Fax:
Practice Address - Street 1:115 CRESCENT COMMONS DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-2751
Practice Address - Country:US
Practice Address - Phone:919-851-5055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily