Provider Demographics
NPI:1053616508
Name:BLAIR, TONI ROCHELLE (LPN)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:ROCHELLE
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 1:101 CIRCLEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-9410
Mailing Address - Country:US
Mailing Address - Phone:740-970-2130
Mailing Address - Fax:
Practice Address - Street 1:101 CIRCLEVIEW DR
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-9410
Practice Address - Country:US
Practice Address - Phone:740-970-2130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.140663-M-IV164W00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No164W00000XNursing Service ProvidersLicensed Practical Nurse