Healthcare Provider Details

I. General information

NPI: 1639515885
Provider Name (Legal Business Name): TERESA L BLAIR CNM - WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 01/19/2025
Certification Date: 01/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5826 E FRANKLIN RD
NAMPA ID
83687-5020
US

IV. Provider business mailing address

226 ASHVILLE AVE STE 20
CARY NC
27518-6660
US

V. Phone/Fax

Practice location:
  • Phone: 208-593-6340
  • Fax: 208-593-6341
Mailing address:
  • Phone: 919-852-1053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM57009
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberM002120
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: