Individual
WADE BLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FPMHNP-BC
Contact information
Practice address
1519 NYE RD, LYONS, NY 14489-9133
(315) 946-5722
(315) 946-5726
Mailing address
6218 WADSWORTH RD, WOLCOTT, NY 14590-9613
(585) 217-6783
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
403584
NY
Other
Enumeration date
08/13/2021
Last updated
09/11/2021
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