Healthcare Provider Details

I. General information

NPI: 1235482928
Provider Name (Legal Business Name): CHRISTINE H BLAIR PNP-PC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 BROOKFIELD ROAD SUITE 200
MEMPHIS TN
38119
US

IV. Provider business mailing address

115 RIVERWALK PL
MEMPHIS TN
38103-0847
US

V. Phone/Fax

Practice location:
  • Phone: 901-761-1880
  • Fax: 901-683-2048
Mailing address:
  • Phone: 865-356-2017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number17077
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: