Provider Demographics
NPI:1255891115
Name:BLAIR, ANNALISIYA BRIDGETTE (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:ANNALISIYA
Middle Name:BRIDGETTE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 494946
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75049-4946
Mailing Address - Country:US
Mailing Address - Phone:386-265-8070
Mailing Address - Fax:
Practice Address - Street 1:4242 DUCK CREEK DR APT 102
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-6978
Practice Address - Country:US
Practice Address - Phone:386-265-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist