Provider Demographics
NPI:1639515885
Name:BLAIR, TERESA L (CNM - WHNP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:L
Last Name:BLAIR
Suffix:
Gender:F
Credentials:CNM - WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 ASHVILLE AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6660
Mailing Address - Country:US
Mailing Address - Phone:919-852-1053
Mailing Address - Fax:
Practice Address - Street 1:226 ASHVILLE AVE STE 20
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518
Practice Address - Country:US
Practice Address - Phone:919-852-1053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARM002120176B00000X, 176B00000X
IDCNM57009367A00000X
UT367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife