Provider Demographics
NPI:1760738694
Name:NUNN, BLAIRE
Entity Type:Individual
Prefix:
First Name:BLAIRE
Middle Name:
Last Name:NUNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 RED SCHOOL LN
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-2230
Mailing Address - Country:US
Mailing Address - Phone:908-859-0200
Mailing Address - Fax:908-859-1231
Practice Address - Street 1:390 RED SCHOOL LN
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2230
Practice Address - Country:US
Practice Address - Phone:908-859-0200
Practice Address - Fax:908-859-1231
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00723600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist