Individual
MRS. CHARLENE LYDIA BLAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRT, RCP
Contact information
Practice address
343 TECHNOLOGY DR, SUITE 1110, GARNER, NC 27529-7949
(919) 780-5900
(919) 780-5905
Mailing address
343 TECHNOLOGY DR, SUITE 1110, GARNER, NC 27529-7949
(919) 780-5900
(919) 780-5905
Taxonomy
Speciality
Code
Description
License number
State
2278P1004X
Pulmonary Diagnostics Certified Respiratory Therapist
Primary
A-4125
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139EE
BLUE SHIELD NC
NC
05
—
7492701
—
NC
01
—
A-4125
LICENSE
NC
Enumeration date
02/06/2006
Last updated
05/10/2011
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