Individual
VICTORIA L BLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
2001 S WOODRUFF AVE STE 15B, IDAHO FALLS, ID 83404-6372
(208) 357-4633
(208) 419-0690
Mailing address
PO BOX 1783, IDAHO FALLS, ID 83403-1783
(208) 552-8774
(208) 523-2025
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
N21972
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N21972
NURSING LICENSE
ID
01
—
NP772A
NURSE PRACTITIONER
ID
Enumeration date
01/11/2007
Last updated
03/23/2018
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