Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1255891115 |
---|---|
Provider Name | Annalisiya Bridgette Blair |
First Address | Garland, TX 75049-4946 |
Second Address | Garland, TX 75043-6978 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2019 |
Last Update Date | 25/03/2019 |