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General NPI Number Information
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NPI Number | 1366033946
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Entity Type | Individual
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Provider Name | KATHLEEN ROSE BLAIR RN
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Gender | Female
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Dates
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Enumeration Date | 01/27/2021
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | 820 E 29TH ST
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City | SOUTH SIOUX CITY
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State | NE
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Zip | 68776-3344
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Country | US
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Telephone | 402-494-3916
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Fax |
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Provider Business Mailing Address
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Address Line | 4230 WAR EAGLE DR
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City | SIOUX CITY
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State | IA
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Zip | 51109-1700
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Country | US
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Telephone | 712-224-4300
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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 | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | R027460
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License Number State | SD
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