Provider Demographics
NPI:1770138463
Name:BLAIR, COURTNEY LYNN
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LYNN
Last Name:BLAIR
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 1:3881 MARSEILLES GALION RD W
Mailing Address - Street 2:
Mailing Address - City:MORRAL
Mailing Address - State:OH
Mailing Address - Zip Code:43337-9354
Mailing Address - Country:US
Mailing Address - Phone:740-244-3659
Mailing Address - Fax:
Practice Address - Street 1:3881 MARSEILLES GALION RD W
Practice Address - Street 2:
Practice Address - City:MORRAL
Practice Address - State:OH
Practice Address - Zip Code:43337-9354
Practice Address - Country:US
Practice Address - Phone:740-244-3659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.168758.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse