Healthcare Provider Details

I. General information

NPI: 1275447971
Provider Name (Legal Business Name): BLAIR OLIVIA FIALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 E 56TH ST APT 15
KEARNEY NE
68847-4814
US

IV. Provider business mailing address

312 N ELM ST STE 101
GRAND ISLAND NE
68801-4509
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-9255
  • Fax:
Mailing address:
  • Phone: 308-382-9255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: