Individual
BLAIR FIFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11104 PARKVIEW CIRCLE DR STE 20, FORT WAYNE, IN 46845-1733
(260) 425-6940
(260) 425-6949
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71005863A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201325310
—
IN
Enumeration date
07/15/2015
Last updated
10/07/2022
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