Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 2015007284 | MO |
NPI | 1013397132 |
---|---|
Provider Name | Blair Elise Lansford |
First Address | Columbia, MO 65203-3248 |
Second Address | Columbia, MO 65203-3639 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2015 |
Last Update Date | 03/06/2015 |