Provider Demographics
NPI:1104630797
Name:BLAIR, JENNIFER KAE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 ARENA ST
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:NE
Mailing Address - Zip Code:68974-6101
Mailing Address - Country:US
Mailing Address - Phone:402-621-0214
Mailing Address - Fax:
Practice Address - Street 1:1317 3RD ST
Practice Address - Street 2:
Practice Address - City:DESHLER
Practice Address - State:NE
Practice Address - Zip Code:68340-9881
Practice Address - Country:US
Practice Address - Phone:308-352-8482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant