Provider Demographics
NPI:1962238550
Name:BLAIR, CARLEY SAIGE
Entity type:Individual
Prefix:
First Name:CARLEY
Middle Name:SAIGE
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 1:148 TEE DR
Mailing Address - Street 2:
Mailing Address - City:MAIDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26541-1103
Mailing Address - Country:US
Mailing Address - Phone:606-232-9217
Mailing Address - Fax:
Practice Address - Street 1:148 TEE DR
Practice Address - Street 2:
Practice Address - City:MAIDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26541-1103
Practice Address - Country:US
Practice Address - Phone:606-232-9217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV96867163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine