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General NPI Number Information
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NPI Number | 1043966534
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Entity Type | Individual
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Provider Name | IANNA BLAIR
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Gender | Female
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Dates
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Enumeration Date | 02/23/2022
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 11 FRANKLIN PL
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City | WOODMERE
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State | NY
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Zip | 11598-1216
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Country | US
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Telephone | 516-341-0151
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Fax |
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Provider Business Mailing Address
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Address Line | 837 JEFFERSON ST
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City | BALDWIN
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State | NY
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Zip | 11510-4630
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Country | US
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Telephone | 347-764-8910
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 344253
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License Number State | NY
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