Provider Demographics
NPI:1801604350
Name:BLAIR, SALLY MAE
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:MAE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:MAE
Other - Last Name:CONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3401 PINE ST NW
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8047
Mailing Address - Country:US
Mailing Address - Phone:330-417-9118
Mailing Address - Fax:
Practice Address - Street 1:3401 PINE ST NW
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8047
Practice Address - Country:US
Practice Address - Phone:330-417-9118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide