Provider Demographics
NPI:1801249511
Name:BLAIR, RACHEL (LM)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 COUNTY ROAD 4208
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:TX
Mailing Address - Zip Code:75422-1709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1875 COUNTY ROAD 4208
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:TX
Practice Address - Zip Code:75422-1709
Practice Address - Country:US
Practice Address - Phone:903-456-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99111175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay