Individual
MRS. TRINA GEBAUER BLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
3415 53RD AVE, BETTENDORF, IA 52722-6976
(563) 742-4350
(563) 742-4355
Mailing address
3415 53RD AVE, BETTENDORF, IA 52722-6976
(563) 742-4350
(563) 742-4355
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001563
IA
363A00000X
Physician Assistant
Primary
085002304
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116106
HEALTH ALLIANCE
—
05
—
1598738635
—
IA
01
—
37592
BLUE CROSS BLUE SHIELD
IA
01
—
P00277546
MEDICARE RAILROAD
—
Enumeration date
02/09/2006
Last updated
01/15/2014
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