Individual
BLAIRE MANDERVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
40 N MAIN AVE, ALBANY, NY 12203-1481
(518) 453-6707
(518) 453-2519
Mailing address
442 AIKEN AVE # A, RENSSELAER, NY 12144-2522
(518) 227-9989
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
827512
NY
Other
Enumeration date
09/26/2022
Last updated
09/26/2022
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