Provider Demographics
NPI:1841313103
Name:MCQUEEN BLAIR, ANN SYNNESTVEDT (DNP, MSN,CRNP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:SYNNESTVEDT
Last Name:MCQUEEN BLAIR
Suffix:
Gender:F
Credentials:DNP, MSN,CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 BRANDON AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0001
Mailing Address - Country:US
Mailing Address - Phone:434-924-5362
Mailing Address - Fax:
Practice Address - Street 1:550 BRANDON AVENUE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:23908
Practice Address - Country:US
Practice Address - Phone:434-924-5362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP006099B363LF0000X
PASP0001593G363LW0102X
VA0024177021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1841313103Medicaid