Healthcare Provider Details

I. General information

NPI: 1467893701
Provider Name (Legal Business Name): REBECCA L BLAIR CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA L HAUSS CPNP

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 WALPOLE ST STE 2
NORWOOD MA
02062-3351
US

IV. Provider business mailing address

17 RUSSELL RD
WINCHESTER MA
01890-1930
US

V. Phone/Fax

Practice location:
  • Phone: 508-444-9818
  • Fax:
Mailing address:
  • Phone: 860-966-9901
  • Fax: 860-966-9901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5007098
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF382474
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2319505
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number658448
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number270864
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: