Provider Demographics
NPI:1386472603
Name:HUNT, BLAIR RENEE (AGCNS-BC)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:RENEE
Last Name:HUNT
Suffix:
Gender:F
Credentials:AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 PALM DALE DR SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9668
Mailing Address - Country:US
Mailing Address - Phone:269-341-0467
Mailing Address - Fax:
Practice Address - Street 1:2110 PALM DALE DR SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9668
Practice Address - Country:US
Practice Address - Phone:269-341-0467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2019044763364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist