Provider Demographics
NPI:1851014633
Name:BLAIR, THERESA CLAIR (LPN)
Entity Type:Individual
Prefix:MISS
First Name:THERESA
Middle Name:CLAIR
Last Name:BLAIR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 W 168TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3703
Mailing Address - Country:US
Mailing Address - Phone:212-740-1780
Mailing Address - Fax:
Practice Address - Street 1:651 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3703
Practice Address - Country:US
Practice Address - Phone:212-740-1780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33485801164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse