Provider Demographics
NPI:1922109859
Name:BLAIR, MONVELIA THERESA (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MONVELIA
Middle Name:THERESA
Last Name:BLAIR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4233 S 273RD PL
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-2025
Mailing Address - Country:US
Mailing Address - Phone:253-852-8618
Mailing Address - Fax:
Practice Address - Street 1:4233 S 273RD PL
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-2025
Practice Address - Country:US
Practice Address - Phone:253-852-8618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP300050092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB13486Medicaid
WA9623539Medicare ID - Type Unspecified
WAAB13486Medicaid