Individual
BLAIR A THEIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
35 GOODWIN DR, FESTUS, MO 63028-4122
(636) 933-4141
(636) 931-7007
Mailing address
35 GOODWIN DR, FESTUS, MO 63028-4122
(636) 933-4141
(636) 931-7007
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
2013035893
MO
Other
Enumeration date
09/20/2019
Last updated
02/24/2022
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