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General NPI Number Information
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NPI Number | 1629128483
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Entity Type | Individual
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Provider Name | VICTORIA L BLAIR NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 03/23/2018
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Provider Practice Location Address
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Address Line | 2001 S WOODRUFF AVE STE 15B
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City | IDAHO FALLS
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State | ID
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Zip | 83404-6372
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Country | US
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Telephone | 208-357-4633
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Fax | 208-419-0690
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Provider Business Mailing Address
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Address Line | PO BOX 1783
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City | IDAHO FALLS
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State | ID
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Zip | 83403-1783
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Country | US
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Telephone | 208-552-8774
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Fax | 208-523-2025
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | N21972
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License Number State | ID
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