Provider Demographics
NPI:1316523038
Name:BLAIR, DEBRA
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
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:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26422-0263
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 LYNCH ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26422
Practice Address - Country:US
Practice Address - Phone:304-627-7553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker