MEDICARE: MRS. CATHERINE SUE BLAIR CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	NP-03272	OH

General Provider Information

NPI Number	:	1508904574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHERINE SUE BLAIR CNP

Provider Business Mailing Address
First Line	:	2800 MAPLE AVE
Second Line	:
City	:	ZANESVILLE
State	:	OH
Zip	:	43701-1716
Country	:	US
Telephone Number	:	740-586-6850
Fax Number	:	740-454-4008

Provider Business Practice Location Address
First Line	:	2800 MAPLE AVE
Second Line	:
City	:	ZANESVILLE
State	:	OH
Zip	:	43701-1716
Country	:	US
Telephone Number	:	740-586-6850
Fax Number	:	740-454-4008

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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