Provider Demographics
NPI:1336989102
Name:BLAIR, MITCHELL FINNELL (RN-BSN)
Entity type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:FINNELL
Last Name:BLAIR
Suffix:
Gender:M
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E BAY AVE APT A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92661-1258
Mailing Address - Country:US
Mailing Address - Phone:217-649-1035
Mailing Address - Fax:
Practice Address - Street 1:303 E BAY AVE APT A
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92661-1258
Practice Address - Country:US
Practice Address - Phone:217-649-1035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033936163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty