Provider Demographics
NPI:1710478649
Name:BLAIR, NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:URPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:USS NIMITZ
Mailing Address - Street 2:CVN 68
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:98312
Mailing Address - Country:US
Mailing Address - Phone:301-651-6026
Mailing Address - Fax:
Practice Address - Street 1:USS NIMITZ
Practice Address - Street 2:CVN 68
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:98312
Practice Address - Country:US
Practice Address - Phone:301-651-6026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-26
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351045678208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery