Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 2295488 | MA |
NPI | 1003291121 |
---|---|
Provider Name | Meghan Blair |
First Address | Quincy, MA 02169-4787 |
Second Address | Quincy, MA 02169-4787 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2015 |
Last Update Date | 30/07/2015 |